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
(12003, 11056, 19964, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : medenroll via Best Health Urgent Care & Clinic, PLLC bhucc@claimsmedinc.com  Sub : Medicare Provider Enrollment Notification SEGUN ADEOYE  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.', NULL, NULL, '2021-07-23 10:44:22', '2021-07-23 10:44:22'),
(12004, 11056, 19964, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from : medenroll via Best Health Urgent Care & Clinic, PLLC  Sub : Medicare Provider Enrollment Notification SEGUN ADEOYE  Please see the attached Notification letter.   The issue of signature has been resolved  on the PECOS and informed to Amper Boyce at 5704015489.   If issue will be face regarding this contact her or send the paper signed by the provider through fax at 8774395479', NULL, NULL, '2021-07-27 10:03:19', '2021-07-27 10:03:19'),
(12005, 11056, 19964, NULL, '2021-08-12 00:00:00.000', 'In Process', 'I had words with Amber Boyce at  5704015489. She informed me that application is in the last stages of completion and they gonna send us the approval letter soon.', NULL, NULL, '2021-08-04 15:05:17', '2021-08-04 15:05:17'),
(12006, 11056, 19964, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Approval Email received from : medenroll@novitas-solutions.com  medenroll via Best Health Urgent Care & Clinic, PLLC  Sub : Medicare Provider Enrollment Notification SEGUN ADEOYE  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.   Novitas Solutions, Inc., and its subsidiary and affiliate companies are not responsible for errors or omissions in this message or its attachments (hereinafter collectively \"communication\").  Any personal comments made in this communication do not reflect the views of Novitas Solutions, Inc. The information contained in this communication may be privileged and/or confidential and solely for the use of the intended recipient or protected from disclosure under applicable law.  If you are not the intended recipient or the individual responsible for delivering to the intended recipient, please (1) be advised that any review, use, dissemination, forwarding, printing or copying of this communications IS STRICTLY PROHIBITED; (2) notify sender immediately by telephone and (3) permanently delete or destroy this communication. THANK YOU.  Eff date is :   07/15/2021   Please see attachment.', NULL, NULL, '2021-08-05 16:41:12', '2021-08-05 16:41:12'),
(12007, 11056, 19964, NULL, '2021-08-13 00:00:00.000', 'Approved', 'Approval Email received from : medenroll@novitas-solutions.com  medenroll via Best Health Urgent Care & Clinic, PLLC  Sub : Medicare Provider Enrollment Notification SEGUN ADEOYE  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.   Novitas Solutions, Inc., and its subsidiary and affiliate companies are not responsible for errors or omissions in this message or its attachments (hereinafter collectively \"communication\").  Any personal comments made in this communication do not reflect the views of Novitas Solutions, Inc. The information contained in this communication may be privileged and/or confidential and solely for the use of the intended recipient or protected from disclosure under applicable law.  If you are not the intended recipient or the individual responsible for delivering to the intended recipient, please (1) be advised that any review, use, dissemination, forwarding, printing or copying of this communications IS STRICTLY PROHIBITED; (2) notify sender immediately by telephone and (3) permanently delete or destroy this communication. THANK YOU.  Eff date is :   07/15/2021   Please see attachment.', NULL, NULL, '2021-08-05 16:42:07', '2021-08-05 16:42:07'),
(12008, 11056, 19964, NULL, '2021-08-13 00:00:00.000', 'Approved', 'Approval Email received from : medenroll@novitas-solutions.com  medenroll via Best Health Urgent Care & Clinic, PLLC  Sub : Medicare Provider Enrollment Notification SEGUN ADEOYE  Please see the attached Notification letter.  NOTE:  THIS MESSAGE HAS BEEN SENT FROM AN AUTOMATED E-MAIL BOX FROM THE PROVIDER ENROLLMENT DEPARTMENT.  PLEASE DO NOT SEND ANY REPLY VIA E-MAIL AS THIS MAILBOX IS NOT MONITORED FOR INCOMING E-MAILS.   Novitas Solutions, Inc., and its subsidiary and affiliate companies are not responsible for errors or omissions in this message or its attachments (hereinafter collectively \"communication\").  Any personal comments made in this communication do not reflect the views of Novitas Solutions, Inc. The information contained in this communication may be privileged and/or confidential and solely for the use of the intended recipient or protected from disclosure under applicable law.  If you are not the intended recipient or the individual responsible for delivering to the intended recipient, please (1) be advised that any review, use, dissemination, forwarding, printing or copying of this communications IS STRICTLY PROHIBITED; (2) notify sender immediately by telephone and (3) permanently delete or destroy this communication. THANK YOU.  Eff date is :   07/15/2021   Please see attachment.', NULL, NULL, '2021-08-05 16:42:14', '2021-08-05 16:42:14'),
(12009, 3046, 19965, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:17:11', '2021-03-12 12:17:11'),
(12010, 3040, 19965, NULL, '2021-04-13 00:00:00.000', 'In Process', 'GROUP NAME	           BEST HEALTH URGENT CARE & CL GROUP PTAN	           DZ8560 GROUP NPI	                   1013540962 BUSINESS STATE	           TX EFFECTIVE DATE	           02/25/2020  Reference Number :	21096000908 ', NULL, NULL, '2021-04-06 12:51:36', '2021-04-06 12:51:36'),
(12011, 3040, 19965, NULL, '2021-04-13 00:00:00.000', 'Approved', 'GROUP PTAN	DZ8560 EFFECTIVE DATE	02/25/2020', NULL, NULL, '2021-04-06 12:56:49', '2021-04-06 12:56:49'),
(12012, 3046, 19966, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:17:17', '2021-03-12 12:17:17'),
(12013, 1006, 19966, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:12:49', '2021-04-16 10:12:49'),
(12014, 11056, 19966, NULL, '2021-07-22 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s Approval. ', NULL, NULL, '2021-07-14 17:31:37', '2021-07-14 17:31:37'),
(12015, 3046, 19967, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:18:24', '2021-03-12 12:18:24'),
(12016, 1006, 19967, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:12:54', '2021-04-16 10:12:54'),
(12017, 3046, 19968, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:18:26', '2021-03-12 12:18:26'),
(12018, 1006, 19968, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request has been put on hold as per my discussion with Stephane, he is unable to provide Memorial Hermann with what they are requesting at the moment. We will have to submit a new request at a later time. ', NULL, NULL, '2021-06-07 11:02:12', '2021-06-07 11:02:12'),
(12019, 3046, 19971, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:21:42', '2021-03-12 12:21:42'),
(12020, 1006, 19971, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:06', '2021-04-16 10:13:06'),
(12021, 3046, 19972, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:23:20', '2021-03-12 12:23:20'),
(12022, 3040, 19972, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'I had a word with (DAN G) Multiplan representative and he said for the group contract at least 02 or more provider will be in the group.   Ref: DAN G 04/06/2021 01:43 Pm', NULL, NULL, '2021-04-06 12:46:11', '2021-04-06 12:46:11'),
(12023, 11056, 19972, NULL, '2021-07-20 00:00:00.000', 'Initiated', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Request - BHUCC - Multiplan  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group Best Health Urgent Care & Clinic as there are 2 providers now in the group. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612 Enrollment Status : Need an update from you about this too.  Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633 Enrollment Status : APPROVED ( already )  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-12 14:58:28', '2021-07-12 14:58:28'),
(12024, 11056, 19972, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Request - BHUCC - Multiplan  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group Best Health Urgent Care & Clinic as there are 2 providers now in the group. Kindly inform me about the enrollment procedure as soon as possible? Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612 Enrollment Status : Need an update from you about this too.  Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633 Enrollment Status : APPROVED ( already ) If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-19 14:56:28', '2021-07-19 14:56:28'),
(12025, 11056, 19972, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com>  Sub : ENROLLMENT APPLICATION - MULTIPLAN - BHUCC  Good morning,  Reference # Task ID: 2301831 .Sorry about that, here it is.   Furthermore, If you need any documents & information please let me know.  Thank you!', NULL, NULL, '2021-07-28 16:33:32', '2021-07-28 16:33:32'),
(12026, 11056, 19972, NULL, '2021-08-11 00:00:00.000', 'In Process', 'I had words with Shanda of Multiplan. She informed me that the application or request is in last stages. They will be going to send us welcome packet soon. Ref no. # : 7693390', NULL, NULL, '2021-08-03 17:05:00', '2021-08-03 17:05:00'),
(12027, 11056, 19972, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : ProviderServices@multiplan.com   &  pif@multiplan.com  Sub : Group Nomination Reconsideration  Good Afternoon  Thank you for nominating Best Health Urgent Care and Clinic for the MultiPlan/PHCS network.  Attached is the Group Nomination Reconsideration Form. Please fill out the form and send it back via email to PIF@MultiPlan.com or fax to: 630-245-2435.  Sincerely, Lynn L. Service Advisor MultiPlan', NULL, NULL, '2021-08-10 13:18:47', '2021-08-10 13:18:47'),
(12028, 11056, 19972, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@multiplan.com  &  pif@multiplan.com  Sub : Group Nomination Reconsideration  Good Afternoon!  Hope all is well. Here is the Group Nomination Form for reconsideration of the practice or group mentioned below. Please see the attachment.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  If further any additional information or documents required please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!   Please see the attachment', NULL, NULL, '2021-08-16 12:08:19', '2021-08-16 12:08:19'),
(12029, 11056, 19972, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : registrar   registrar@multiplan.com, MSAPIF   PIF@multiplan.com, christos.ziogas@multiplan.com  Sub : Group Nomination Reconsideration  Good morning!  Hope this email finds you well. I want to inquire about the reconsideration process of my group and and the Group Nomination Reconsideration Form which I have submitted to you on 10th of August,2021. Please respond to this as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  If you have any questions or concerns please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-23 15:18:58', '2021-08-23 15:18:58'),
(12030, 11056, 19972, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : pif@multiplan.com  Sub  : Automatic reply: Group Nomination Reconsideration  Thank you for your interest to participate in MultiPlan\'s provider networks. This message serves as confirmation of receipt.  We are experiencing a high volume response and appreciate your patience while we process your request. Your completed Provider Information Form will be processed in order received.  In order to improve the contracting process, once we have evaluated your information and processed a contract, you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email.  Our contracting and credentialing process takes approximately 90 - 120 days unless otherwise mandated by state law. We will contact you if we require additional information.  This email box is intended for receipt of PIFs Provider Information Forms ONLY.  To inquire about the status of your submission, question on rates, CPT reimbursement values,  or any other inquiries, please contact MultiPlan via email http://provider.multiplan.com or by calling 800-950-7040. Thank you.', NULL, NULL, '2021-09-08 17:00:44', '2021-09-08 17:00:44'),
(12031, 11056, 19972, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Rep : Melissa C  Status : In process & loading  Ref code : 030320k7u  Contact no : (800) 950-7040', NULL, NULL, '2021-09-24 17:08:50', '2021-09-24 17:08:50'),
(12032, 11056, 19972, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Rep : James D  Status : They have sent a Denial letter at the Practice address. Issue is mentioned in it. Confidential.  Ref code : 030320k7u  Contact no : (800) 950-7040', NULL, NULL, '2021-10-05 15:56:33', '2021-10-05 15:56:33'),
(12033, 11056, 19972, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Nomination Tracking Number: 1005215NV  Another application has been submitted.', NULL, NULL, '2021-10-05 16:01:54', '2021-10-05 16:01:54'),
(12034, 11056, 19972, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Rep : Natasha C   Status :  Nomination for the group is received and they are reviewing it. Is in processing. Ancillary contracting is needed for the facility to participate with multiplan.  Ref code  : Natashac1236', NULL, NULL, '2021-10-14 12:36:08', '2021-10-14 12:36:08'),
(12035, 11056, 19972, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep:  Sara S  Status: Still in process. it will take 60-90 days  Ref code: 1005215NV  Contact no : (800) 950-7040', NULL, NULL, '2021-10-21 15:57:15', '2021-10-21 15:57:15'),
(12036, 11056, 19972, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep : Nick  Status: RFI form has to be filled they are going to send it to us. Still in process.  Ref code:  7796105', NULL, NULL, '2021-11-01 12:54:03', '2021-11-01 12:54:03'),
(12037, 11056, 19972, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Rep: James D  Status: Still in process. Reviewing the application.   Ref code: 1005215NV', NULL, NULL, '2021-11-12 17:12:19', '2021-11-12 17:12:19'),
(12038, 11056, 19972, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: To set up a group enrollment has to fill out the nomination. SEID: 211006173965   Ref code: 11292021jamesd  Nomination has been submitted again as a group agreement.', NULL, NULL, '2021-11-29 11:03:42', '2021-11-29 11:03:42'),
(12039, 11056, 19972, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Rep: James D   Status: To set up a group enrollment has to fill out the nomination. SEID: 211006173965   Ref code: 11292021jamesd  Nomination has been submitted again as a group agreement.', NULL, NULL, '2021-11-29 11:03:42', '2021-11-29 11:03:42'),
(12040, 11056, 19972, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from: pif@multiplan.com  Sub: Multiplan Request for Information for Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965   Dear Provider:  We would like to invite you to participate in MultiPlan\'s provider networks.  When you choose to join MultiPlan, the nation\'s oldest and largest independent provider network, you select an organization that delivers patient volume from a diverse base of healthcare payers, offers administrative ease, and helps you evolve with the market through a wide range of network-based solutions.  You can access our Provider Handbook located under Helpful Resources in the Providers section at: www.multiplan.com  If you are interested in signing a MultiPlan Agreement and Provider Application, please complete the attached Request for Information form for each one of your locations and return to us by replying to this email.  Please ONLY use this email for the provider you nominated. If you need to nominate additional providers then please submit your provider nomination request by clicking the following link: Nominate Provider  MultiPlan has implemented an electronic signature process; you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email. If you would like additional information about MultiPlan or the services we offer, please visit our website at:www.multiplan.com  Sincerely,  Gloria Esplana  Director, Network Contract Support', NULL, NULL, '2021-12-08 14:55:58', '2021-12-08 14:55:58'),
(12041, 11056, 19972, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from: pif@multiplan.com  Sub: Multiplan Request for Information for Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965   Dear Provider:  We would like to invite you to participate in MultiPlan\'s provider networks.  When you choose to join MultiPlan, the nation\'s oldest and largest independent provider network, you select an organization that delivers patient volume from a diverse base of healthcare payers, offers administrative ease, and helps you evolve with the market through a wide range of network-based solutions.  You can access our Provider Handbook located under Helpful Resources in the Providers section at: www.multiplan.com  If you are interested in signing a MultiPlan Agreement and Provider Application, please complete the attached Request for Information form for each one of your locations and return to us by replying to this email.  Please ONLY use this email for the provider you nominated. If you need to nominate additional providers then please submit your provider nomination request by clicking the following link: Nominate Provider  MultiPlan has implemented an electronic signature process; you will receive electronic documents for signature via DocuSign. To expedite the contracting process, please follow the instructions included in the DocuSign email. If you would like additional information about MultiPlan or the services we offer, please visit our website at:www.multiplan.com  Sincerely,  Gloria Esplana  Director, Network Contract Support', NULL, NULL, '2021-12-08 14:56:05', '2021-12-08 14:56:05'),
(12042, 11056, 19972, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: pif@multiplan.com  Sub: Multiplan Request for Information for Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965  Good afternoon!  Hope this email finds you well. Please find the attached Multiplan Ancillary Facility Application below.   Thank you! Have a nice day! ', NULL, NULL, '2021-12-17 13:01:34', '2021-12-17 13:01:34'),
(12043, 11056, 19972, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: pif@multiplan.com  Sub: Multiplan Request for Information for Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965  Good afternoon!  Hope this email finds you well. Please find the attached Multiplan Ancillary Facility Application below.   Thank you! Have a nice day! ', NULL, NULL, '2021-12-17 13:01:37', '2021-12-17 13:01:37'),
(12044, 11056, 19972, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Rep: Maegan K    Bhucc: Application is in process. Everything is completed.   Ref code: 7825718', NULL, NULL, '2021-12-23 10:42:01', '2021-12-23 10:42:01'),
(12045, 19067, 19972, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: Mariana.Juarez@multiplan.com  Subject: Fwd: Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965     Good morning,  I received the RFI you submitted to Multiplan for Best Health Urgent Care and Clinic. Without urgent care accreditations, I am not able to proceed. This request will be closed until documentation below is received.     Urgent Care RFI  Urgent Care accreditations - (JC, AAAHC, TCT, NUCCA, IMQ or UCAOA)  General insurance policy  Professional insurance policy  CMS approval letter     Thank you.     Mariana Juarez  Provider Contracting Representative  mariana.juarez@multiplan.com     MultiPlan  25550 Commercentre Drive, Suite 200 Lake Forest, CA 92630  ph: 949-672-1561  fx: 630-245-2462', NULL, NULL, '2022-01-03 14:50:37', '2022-01-03 14:50:37'),
(12046, 19067, 19972, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: Mariana.Juarez@multiplan.com  Subject: Re: Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965  Greetings!  Kindly see the attached form as requested.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 12:00:25', '2022-01-11 12:00:25'),
(12047, 19067, 19972, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: Mariana.Juarez@multiplan.com  Subject: RE: Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965   Thank you!! Still missing the following items:  Urgent Care accreditations - (JC, AAAHC, TCT, NUCCA, IMQ or UCAOA)  General insurance policy  Professional insurance policy  CMS approval letter        Mariana Juarez  Provider Contracting Representative  mariana.juarez@multiplan.com', NULL, NULL, '2022-01-20 20:12:57', '2022-01-20 20:12:57'),
(12048, 22077, 19972, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: Mariana.Juarez@multiplan.com  Subject: Best Health Urgent Care and Clinic - State: TX - SEID: 211006173965  Accreditation is a Multiplan requirement. Please seek urgent care accreditations. Once received, feel free to reach out to me. Your insurance broker should be able to update the policy. Thank you.     Urgent Care accreditations - (JC, AAAHC, TCT, NUCCA, IMQ or UCAOA)           Mariana Juarez  Provider Contracting Representative  mariana.juarez@multiplan.com', NULL, NULL, '2022-04-14 10:00:07', '2022-04-14 10:00:07'),
(12049, 3046, 19973, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:23:27', '2021-03-12 12:23:27'),
(12050, 1006, 19973, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:11', '2021-04-16 10:13:11'),
(12051, 3046, 19974, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:26:13', '2021-03-12 12:26:13'),
(12052, 1006, 19974, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:17', '2021-04-16 10:13:17'),
(12053, 3046, 19975, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:27:23', '2021-03-12 12:27:23'),
(12054, 3040, 19975, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Group participating with Superior Health.   Please see attachment. ', NULL, NULL, '2021-04-06 13:14:15', '2021-04-06 13:14:15'),
(12055, 3046, 19976, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:27:25', '2021-03-12 12:27:25'),
(12056, 1006, 19976, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:23', '2021-04-16 10:13:23'),
(12057, 3046, 19977, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:28:47', '2021-03-12 12:28:47'),
(12058, 3040, 19977, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Email sent to: TCHPnetworkmanagement@texaschildren.org  Subject: Request for Group Contract || Best Health Urgent Care & Clinic || TCHP ||  Greetings,  Hope you are doing well. Can you please advise me the group contract for the practice we want to go under the credentialing process or the group will be added after the provider will be in-network with TCHP.  Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  If you need any additional information please let me know. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-06 13:52:44', '2021-04-06 13:52:44'),
(12059, 1006, 19977, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Currently, TCHP enrollment is on hold because we need to have a supervising physician enrolled to proceed, sent f/u email to Stephane regarding this:  \"Hello Stephane,  I hope you\'re doing well, I just wanted to check in with you if you had any luck getting in touch with Dr. Segun regarding what we discussed in regards to enrollment with TCHP? As he will also need to be enrolled with TCHP under BHUCC.   Thank you. \"', NULL, NULL, '2021-06-07 15:05:31', '2021-06-07 15:05:31'),
(12060, 11056, 19977, NULL, '2021-07-22 00:00:00.000', 'On Hold', 'Confirmation received from the Provider. Now initiating his Medicare and after the Medicare we will work soon on this too!', NULL, NULL, '2021-07-14 16:07:14', '2021-07-14 16:07:14'),
(12061, 11056, 19977, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email received from : neruiz@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Thank you for the clarification Brad.     Looking into the physicians credentials more in-depth, we show she is no longer attested with the group through TCHP and is showing as excluded. We need both the Supervising Physician and NP attested to the group (Best Health Urgent Care & Clinic )under TCHP.     Please follow up with the health plan to get this information updated. Once updated, please submit a new Letter of Interest for both physicians. We are unable to move the process forward under the current request as is.     To update: call TMHP 800-925-9126 opt 3 or go online https://www.tmhp.com/  Waiting for the response of Mr. Segun. To be the Supervising physician for the group in this plan.', NULL, NULL, '2021-09-10 12:00:18', '2021-09-10 12:00:18'),
(12062, 11056, 19977, NULL, '2021-09-17 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-09-10 12:00:48', '2021-09-10 12:00:48'),
(12063, 11056, 19977, NULL, '2021-09-17 00:00:00.000', 'On Hold', 'Email received from : neruiz@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Thank you for the clarification Brad.     Looking into the physicians credentials more in-depth, we show she is no longer attested with the group through TCHP and is showing as excluded. We need both the Supervising Physician and NP attested to the group (Best Health Urgent Care & Clinic )under TCHP.     Please follow up with the health plan to get this information updated. Once updated, please submit a new Letter of Interest for both physicians. We are unable to move the process forward under the current request as is.     To update: call TMHP 800-925-9126 opt 3 or go online https://www.tmhp.com/  Waiting for the response of Mr. Segun. To be the Supervising physician for the group in this plan.', NULL, NULL, '2021-09-10 12:01:00', '2021-09-10 12:01:00'),
(12064, 11056, 19977, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Email sent to : TCHPnetworkmanagement@texaschildren.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning!  Hope all is well. We want to enroll the providers and practice with the Texas Children Health Plan. We do have the Supervising Physician now for the group. Please assist us as soon as possible   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Adeoye, Segun          Supervising Physician Provider NPI# : 1629418025  Provider Name : Tann, Shametria         FNP Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane    FNP Provider NPI# : 1780192633   If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a Blessed Day!', NULL, NULL, '2021-09-14 10:05:43', '2021-09-14 10:05:43'),
(12065, 11056, 19977, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : 	TCHPnetworkmanagement@texaschildren.org Join TCHP jointchp@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract   Good morning!  Hope you had a great and safe weekend. I am still waiting to get assistance on enrolling the below mentioned providers and practice with TCHP. But no one haven\'t responded to my query yet.   Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Stephane Cyriaque (FNP)	1780192633 Shametria Tann  (FNP)	1124615612 Segun Adeoye (Supervising Physician)	1629418025  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 10:02:06', '2021-09-27 10:02:06'),
(12066, 11056, 19977, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email received from :bxgupta@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning Mr.Talha,  Provider Details:  Provider Name : Adeoye, Segun          Supervising Physician-  has been PAR since 2019 Provider NPI# : 1629418025   The 2 NP you wanted to add? I see the email chain that you have been in communication with her but she is no longer works here. If you want to add np to the group and if they are attested to TMHP then please send Provider information form along with W9 and I will have them process. If you have any other concerns please do not hesitate to call me @832-877-3506 or 832-828-1219. Please see attached PIF.   Thank you & have  grreat day!', NULL, NULL, '2021-10-05 08:54:20', '2021-10-05 08:54:20'),
(12067, 11056, 19977, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Hello Ahmed,  I am a contract administrator with Texas Children’s Health Plan. I am working on your contract. Can you please provide me with a roster of the practitioners in your group practice? You can use the attached spreadsheet and return to me. The providers will be listed as an Exhibit to the contract.  Thank you,', NULL, NULL, '2021-10-21 14:41:49', '2021-10-21 14:41:49'),
(12068, 11056, 19977, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Please DocuSign: AGMT_BEST HEALTH URGENT CARE & CLINIC, PLLC.pdf   ', NULL, NULL, '2021-10-21 16:57:24', '2021-10-21 16:57:24'),
(12069, 11056, 19977, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good afternoon Melissa!  Hope this email finds you well. Please find the roster of the practitioners in the practice in the attachments.  Furthermore, If you need any additional information or documents feel free to reach out to me, I will be happy to assist you.  Thank you! Take Care!', NULL, NULL, '2021-11-01 10:39:31', '2021-11-01 10:39:31'),
(12070, 11056, 19977, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Email received from: mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC   Hello Talha,  Texas Children’s Health Plan’s Provider Information Form is the form needed to get the providers through our contracting and credentialing phases. I already have the PIF for Stephane but will need the form completed for  Shemetria and Segun. If you have submitted them previously, you can send them to me but ensure that today’s date is on the form so we don’t see it as a duplicate.     I’ll sent the contract over to Stephane just a few minutes ago.     The PIF is linked here if you need it.  https://www.texaschildrenshealthplan.org/sites/default/files/pdf/ND-2011-347%20Provider%20Information%20Form_2021_Fillable_update%2004.21.pdf     Thanks,  Melissa  Forms has been submitted and attached.', NULL, NULL, '2021-11-12 17:34:47', '2021-11-12 17:34:47'),
(12071, 11056, 19977, NULL, '2021-11-23 00:00:00.000', 'Approved', 'Email received from: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Hello Ahmed,  The contract has been executed with an effective date of 12/01/2021. However, only Stephane Cyriaque has completed credentialing. Dr. Tann and Adeoye are still in credentialing and do not have an effective date yet.  The only provider who is effective with the 12/1/21 date is Stephanie Cyriaque.   The contract agreement is effective 12/1/21 for the group  See attached, but you will also receive a welcome packet with more information.', NULL, NULL, '2021-11-16 15:34:23', '2021-11-16 15:34:23'),
(12072, 3046, 19978, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:28:49', '2021-03-12 12:28:49'),
(12073, 1006, 19978, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:29', '2021-04-16 10:13:29'),
(12074, 1005, 19978, NULL, '2021-09-17 00:00:00.000', 'Not Eligible', 'We have requested Stephane and Segun to confirm us in writing to allow us to use Segun\'s Supervisory Benefits for TCHP. Havnt received a response from Segun. ', NULL, NULL, '2021-09-10 10:35:44', '2021-09-10 10:35:44'),
(12075, 11056, 19978, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Email sent to : TCHPnetworkmanagement@texaschildren.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning!  Hope all is well. We want to enroll the providers and practice with the Texas Children Health Plan. We do have the Supervising Physician now for the group. Please assist us as soon as possible   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Adeoye, Segun          Supervising Physician Provider NPI# : 1629418025  Provider Name : Tann, Shametria         FNP Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane    FNP Provider NPI# : 1780192633   If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a Blessed Day!', NULL, NULL, '2021-09-14 10:04:57', '2021-09-14 10:04:57'),
(12076, 11056, 19978, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : 	TCHPnetworkmanagement@texaschildren.org Join TCHP jointchp@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract   Good morning!  Hope you had a great and safe weekend. I am still waiting to get assistance on enrolling the below mentioned providers and practice with TCHP. But no one haven\'t responded to my query yet.   Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Stephane Cyriaque (FNP)	1780192633 Shametria Tann  (FNP)	1124615612 Segun Adeoye (Supervising Physician)	1629418025  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 10:02:01', '2021-09-27 10:02:01'),
(12077, 11056, 19978, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email received from :bxgupta@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning Mr.Talha,  Provider Details:  Provider Name : Adeoye, Segun          Supervising Physician-  has been PAR since 2019 Provider NPI# : 1629418025   The 2 NP you wanted to add? I see the email chain that you have been in communication with her but she is no longer works here. If you want to add np to the group and if they are attested to TMHP then please send Provider information form along with W9 and I will have them process. If you have any other concerns please do not hesitate to call me @832-877-3506 or 832-828-1219. Please see attached PIF.   Thank you & have  grreat day!', NULL, NULL, '2021-10-05 08:54:13', '2021-10-05 08:54:13'),
(12078, 11056, 19978, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Hello Ahmed,  I am a contract administrator with Texas Children’s Health Plan. I am working on your contract. Can you please provide me with a roster of the practitioners in your group practice? You can use the attached spreadsheet and return to me. The providers will be listed as an Exhibit to the contract.  Thank you,', NULL, NULL, '2021-10-21 14:41:43', '2021-10-21 14:41:43'),
(12079, 11056, 19978, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Please DocuSign: AGMT_BEST HEALTH URGENT CARE & CLINIC, PLLC.pdf  Agreement has been signed  ', NULL, NULL, '2021-10-21 16:58:06', '2021-10-21 16:58:06'),
(12080, 11056, 19978, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good afternoon Melissa!  Hope this email finds you well. Please find the roster of the practitioners in the practice in the attachments.  Furthermore, If you need any additional information or documents feel free to reach out to me, I will be happy to assist you.  Thank you! Take Care!', NULL, NULL, '2021-11-01 10:39:25', '2021-11-01 10:39:25'),
(12081, 11056, 19978, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Email received from: mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC   Hello Talha,  Texas Children’s Health Plan’s Provider Information Form is the form needed to get the providers through our contracting and credentialing phases. I already have the PIF for Stephane but will need the form completed for  Shemetria and Segun. If you have submitted them previously, you can send them to me but ensure that today’s date is on the form so we don’t see it as a duplicate.     I’ll sent the contract over to Stephane just a few minutes ago.     The PIF is linked here if you need it.  https://www.texaschildrenshealthplan.org/sites/default/files/pdf/ND-2011-347%20Provider%20Information%20Form_2021_Fillable_update%2004.21.pdf     Thanks,  Melissa  Forms has been submitted and attached.', NULL, NULL, '2021-11-12 17:34:39', '2021-11-12 17:34:39'),
(12082, 11056, 19978, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Sub:  Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Thank you. Your providers have been sent over to our credentialing department. Once they have cleared, I’ll send the contract to our president for execution and an effective date can be assigned at that time.     Thank you for your quick responses. Happy Friday!', NULL, NULL, '2021-11-29 13:52:36', '2021-11-29 13:52:36'),
(12083, 11056, 19978, NULL, '2021-12-08 00:00:00.000', 'Approved', 'Email received from:   bxgupta@texaschildrens.org  Sub:  Welcome Letter - Segun P. Adeoye, MD  Greetings,      Welcome to TCHP Segun P. Adeoye, MD is now participating with Texas Children’s Health Plan under Best Health Urgent Care & Clinic, 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.      Segun P. Adeoye, MD 3003 Texas Pkwy Unit B Houston, TX 77489  Dear Segun P. Adeoye, MD  Welcome to Texas Children’s Health Plan! You were credentialed as a participating provider with Texas Children’s Health Plan.    Eff date:  12/01/2021  Thank you and have a great day!   ​  Respectfully, Bharvi Gupta Contract Specialist  6330 West Loop South Bellaire, Texas 77401 bxgupta@texaschildrens.org    Please see the attached Welcome Letter.', NULL, NULL, '2021-12-01 09:30:56', '2021-12-01 09:30:56'),
(12084, 3046, 19979, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:29:48', '2021-03-12 12:29:48'),
(12085, 1006, 19979, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:40', '2021-04-16 10:13:40'),
(12086, 3046, 19980, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:31:03', '2021-03-12 12:31:03'),
(12087, 1006, 19980, NULL, '2021-04-23 00:00:00.000', 'On Hold', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from nathan_riojas@uhc.com  Thank you for your interest in wanting to be contracted with UnitedHealthcare. Currently the market is closed for (Commercial, Medicare, and Community & State (Medicaid) product lines.)  The Care Coordination Department (800-635-6882) can assist to see if any  medical exceptions (single case agreements per member) can be made for our non-contracted providers.  Please let us know if we can assist further.  Thank you!  Have a Blessed day. :) ', NULL, NULL, '2021-04-16 12:39:53', '2021-04-16 12:39:53'),
(12088, 11056, 19980, NULL, '2021-07-20 00:00:00.000', 'Initiated', 'Email sent to : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Greetings,  Hope you are doing well. I want to enroll the below mentioned provider and Group. Kindly guide me with the procedure how to enroll them.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.    Thank you! Have a great day!', NULL, NULL, '2021-07-12 17:04:34', '2021-07-12 17:04:34'),
(12089, 11056, 19980, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Hello,     Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed  TANN, SHAMETRIA  - 7674348 /TAX ID 844737737 regarding enrolling group and provider. Per your provider’s profile, I can confirm that group is enrolled, and the provider is linked to the group, waiting to be added to group contract. Open phycon add to group PR-5925454 being work on. Need more time to complete, 30 days.     Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. Have a wonderful day!     Thank You,     Aldean Mosley  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:57:32', '2021-07-15 15:57:32'),
(12090, 11056, 19980, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : aldean_mosley@uhc.com  & networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Hello,  Thank you for reaching back out to UnitedHealth Care.  I submitted an escalation today requesting that provider be added to group contract, load contract lines, ETA 10 days, there is nothing additional required of you other than following up in 10 days to check the contract status for the provider.     Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. Have a wonderful day!  Thank You, Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-23 12:28:32', '2021-07-23 12:28:32'),
(12091, 11056, 19980, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from  : networkhelp@uhc.com  Sub : Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    SHAMETRIA TANN  has had two request for credentialing. Is this provider not a urgent care seeing walk-ins or seeing patients by appointment?  Walk-in providers do not require credentialing by appointment does.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-27 10:57:29', '2021-07-27 10:57:29'),
(12092, 11056, 19980, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	networkhelp@uhc.com  Sub :  ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned provider and Group for UHC Plan (Texas Star Kids). Kindly provide me with the updates soon.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address : 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-08-04 08:35:30', '2021-08-04 08:35:30'),
(12093, 11056, 19980, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	networkhelp@uhc.com  Sub :  ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned provider and Group for UHC Plan (Texas Star Kids). Kindly provide me with the updates soon.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address : 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-08-04 08:35:30', '2021-08-04 08:35:30'),
(12094, 11056, 19980, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : 	networkhelp@uhc.com  Sub :  ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned provider and Group for UHC Plan (Texas Star Kids). Kindly provide me with the updates soon.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address : 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-08-10 14:40:10', '2021-08-10 14:40:10');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(12095, 11056, 19980, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Hi Talha  Thank you for emailing Network help.  The Group and Provider has been updated with  UHC Plan (Texas Star Kids) plan.   Attached is the Product code list.   Thanks Pam  Pamela(Pam) Preece UnitedHealthcare Network Management Resource Team (NMRT)   Please see the attachment.', NULL, NULL, '2021-08-16 14:22:59', '2021-08-16 14:22:59'),
(12096, 3046, 19981, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:31:05', '2021-03-12 12:31:05'),
(12097, 1006, 19981, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:47', '2021-04-16 10:13:47'),
(12098, 3046, 19982, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:33:01', '2021-03-12 12:33:01'),
(12099, 3040, 19982, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Email sent to: Group Contract || Best Health Urgent Care & Clinic || Group || UHC ||  Subject: Group Contract || Best Health Urgent Care & Clinic || Group || UHC ||  Greetings,   Hope you are doing well. Can you please advise me if the group is eligible for the group contract as we have only one provider under the practice.   Below are the practice details:  Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  If you need any additional information please feel free to call or email me. Waiting to hear form you soon.   Thank you ', NULL, NULL, '2021-04-06 15:01:30', '2021-04-06 15:01:30'),
(12100, 3040, 19982, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from nathan_riojas@uhc.com  Thank you for your interest in wanting to be contracted with UnitedHealthcare. Currently the market is closed for (Commercial, Medicare, and Community & State (Medicaid) product lines.)  The Care Coordination Department (800-635-6882) can assist to see if any  medical exceptions (single case agreements per member) can be made for our non-contracted providers.  Please let us know if we can assist further.  Thank you!  Have a Blessed day. :)', NULL, NULL, '2021-04-09 15:38:25', '2021-04-09 15:38:25'),
(12101, 11056, 19982, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Email sent to : networkhelp@uhc.com  Sub : Group Contract Request || Best Health Urgent Care & Clinic || UHC ||   Greetings,  Hope you are doing well. Could you please advise me if the group is eligible for the group contract as we have only one provider under the practice. Below are the practice details.  Practice: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any additional information please feel free to call or email me. Waiting to hear form you soon.  Thank you!', NULL, NULL, '2021-06-28 13:59:46', '2021-06-28 13:59:46'),
(12102, 11056, 19982, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Request - BHUCC - United HealthCare  Greetings,  Hope you are doing well. I wanted to enroll our group and provider mentioned below in United HealthCare. Kindly respond to me soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Providers: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-12 14:30:44', '2021-07-12 14:30:44'),
(12103, 11056, 19982, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Hello,   Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed  TANN, SHAMETRIA  - 7674348 /TAX ID 844737737 regarding enrolling group and provider. Per your provider’s profile, I can confirm that group is enrolled, and the provider is linked to the group, waiting to be added to group contract. Open phycon add to group PR-5925454 being work on. Need more time to complete, 30 days.   Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com (link: mailto:networkhelp@uhc.com). Have a wonderful day!   Thank You,   Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:37:50', '2021-07-15 15:37:50'),
(12104, 11056, 19982, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Enrollment Request - BHUCC - United HealthCare  Good Morning,     Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.      An OptumID will be required to access the credentialing tool. To register or view a guide, please go to UHCprovider.com/newuser. Should you need assistance in registering for an Optum ID or if you need assistance or status on updating your existing access, please contact the online/LINK help desk at (866)842-3278, option 1.     For assistance in provisioning your current Optum Login ID to access OnBoardPRO for this specific group/Tax ID, please see the attached quick reference guide on how to identify the group’s Tax ID password administrator.     For additional resources, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html?cid-none     Please let us know if we can assist further via email.        Thanks,  Keaira Johnson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:55:30', '2021-07-15 15:55:30'),
(12105, 11056, 19982, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from lashonda_lymon@uhc.com  Hello,   Atinuke Dada MPIN 7587679 is linked to TIN 852432283 and credentialed and will have active Commercial contracts effective 07/15/21   Oladipo Dada MPIN 4864632 is linked to TIN 852432283 and credentialed as delegated with Cardiovascular Care Providers Inc (CVCP) and will have active Commercial contracts effective 07/15/21       LaShonda Lymon UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-23 12:37:20', '2021-07-23 12:37:20'),
(12106, 11056, 19982, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for BEST HEALTH URGENT CARE & CLINIC*** - 7341276, and  TANN, SHAMETRIA  - 7674348.     Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please let us know if we can assist further.     Thank you,     Aldean Mosley  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-27 12:37:28', '2021-07-27 12:37:28'),
(12107, 11056, 19982, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  SUB : Secure Message from keaira_johnson@uhc.com  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  After further review, I show the group and provider are both loaded and associated with Practice Tax ID # : 84-4737737.  I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested. Additionally, if you are wanting the specific lines of business that the providers are linked to, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.  If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     In regards to adding a new practitioner to your existing Medical Group Participation Agreement.      There are two ways you can submit your request:  a.      For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).  b.      If you don’t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to hpdemo@uhc.com.   You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.     Please let us know if we can assist further via email.        Thanks,  Keaira Johnson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-28 17:40:41', '2021-07-28 17:40:41'),
(12108, 11056, 19982, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Approval email received from : networkhelp@uhc.com  Sub : Secure Message from keaira_johnson@uhc.com  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  After further review, I show the group and provider are both loaded and associated with Practice Tax ID # : 84-4737737.  I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested. Additionally, if you are wanting the specific lines of business that the providers are linked to, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.  If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).  In regards to adding a new practitioner to your existing Medical Group Participation Agreement.   There are two ways you can submit your request:  a.      For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).  b.      If you don’t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to hpdemo@uhc.com.   You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.  Please let us know if we can assist further via email.  Thanks,  Keaira Johnson UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-29 14:44:33', '2021-07-29 14:44:33'),
(12109, 3046, 19983, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:33:03', '2021-03-12 12:33:03'),
(12110, 1006, 19983, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:13:53', '2021-04-16 10:13:53'),
(12111, 3040, 19984, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:33:26', '2021-03-12 12:33:26'),
(12112, 3040, 19984, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:16:14', '2021-03-26 17:16:14'),
(12113, 3040, 19984, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Good Morning Katherine,  Hope you had a great weekend. Please advise me if the below mentioned providers are enrolled with Tricare. Because the providers are showing on provider portal but not all three locations. I wanted to add their additional locations.  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-03-29 09:30:42', '2021-03-29 09:30:42'),
(12114, 3040, 19984, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  > Good Morning,  Please provide a credentialing application for both providers: Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Respectfully, Katherine Moten TRICARE Community Liaison II Humana', NULL, NULL, '2021-03-29 09:32:22', '2021-03-29 09:32:22'),
(12115, 3040, 19984, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of the request in the Tricare for our group Valley Med Urgent Care PLLC under below locations. Can you please send me the effective date for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis (Still not showing on portal) Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero (Showing in all three location with NOT REQUIRED Status) Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego (Showing on portal in all three locations) (Need Effective Date) Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa (Not showing on provider portal) Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 12:16:25', '2021-04-15 12:16:25'),
(12116, 3040, 19984, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:12:20', '2021-06-01 09:12:20'),
(12117, 3040, 19984, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Please find the attached provider credentialing application form along with the documents as per you previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-03 14:55:43', '2021-06-03 14:55:43'),
(12118, 3040, 19984, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:46:00', '2021-06-21 10:46:00'),
(12119, 3040, 19984, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:49:17', '2021-06-21 10:49:17'),
(12120, 3040, 19984, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-09 11:19:05', '2021-07-09 11:19:05'),
(12121, 3040, 19984, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Karherine,   Hope you are doing well. Please find attached screenshot from Tricare provider portal for Garcia Homero and it\'s showing the \"Action Needed\". Can you please check & advise. Also I wanted to know the enrollment status for the another provider in Tricare under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero (Showing on Provider portal \"Action Needed\") Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego (Advise the enrollment status) Provider NPI# 1568929800  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 15:25:39', '2021-09-09 15:25:39'),
(12122, 10057, 19984, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:52', '2021-10-21 15:27:52'),
(12123, 10057, 19984, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556             Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application,  complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558            Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit. NPI 1659919702                 Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800                 Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857                 Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502                 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21   Thank you, Jacque Trenz  Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-11-03 11:36:38', '2021-11-03 11:36:38'),
(12124, 3040, 19985, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:34:24', '2021-03-12 12:34:24'),
(12125, 3040, 19985, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'I had a word with Tricare (Angila) representative and I Waiting for the confirmation email.', NULL, NULL, '2021-03-26 16:45:21', '2021-03-26 16:45:21'),
(12126, 3040, 19985, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:12:33', '2021-06-01 09:12:33'),
(12127, 3040, 19985, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Group added under the McAllen Location. Please see attachment. ', NULL, NULL, '2021-06-21 09:45:21', '2021-06-21 09:45:21'),
(12128, 3040, 19986, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:34:56', '2021-03-12 12:34:56'),
(12129, 3040, 19986, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:17:50', '2021-03-26 17:17:50'),
(12130, 3040, 19986, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of the request in the Tricare for our group Valley Med Urgent Care PLLC under below locations. Can you please send me the effective date for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis (Still not showing on portal) Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero (Showing in all three location with NOT REQUIRED Status) Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego (Showing on portal in all three locations) (Need Effective Date) Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa (Not showing on provider portal) Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 12:14:21', '2021-04-15 12:14:21'),
(12131, 3040, 19986, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:12:57', '2021-06-01 09:12:57'),
(12132, 3040, 19986, NULL, '2021-06-10 00:00:00.000', 'New/Not Initiated', 'Email rcvd from: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Provider 1:  Provider Name: Escobar, Angiollet Solis – sent a request to have this location loaded correctly.  Provider NPI# 1962917997  Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   ', NULL, NULL, '2021-06-03 13:21:25', '2021-06-03 13:21:25'),
(12133, 3040, 19986, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Provider 1:  Provider Name: Escobar, Angiollet Solis – sent a request to have this location loaded correctly.  Provider NPI# 1962917997  Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166 ', NULL, NULL, '2021-06-03 13:21:44', '2021-06-03 13:21:44'),
(12134, 3040, 19986, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Provider is participating under the McAllen location. Please see attachment. ', NULL, NULL, '2021-06-21 09:44:10', '2021-06-21 09:44:10'),
(12135, 3040, 19986, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Provider is participating under the McAllen location. Please see attachment.  ', NULL, NULL, '2021-06-21 09:44:47', '2021-06-21 09:44:47'),
(12136, 3040, 19987, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:35:18', '2021-03-12 12:35:18'),
(12137, 3040, 19987, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:15:26', '2021-03-26 17:15:26'),
(12138, 3040, 19987, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Good Morning Katherine,  Hope you had a great weekend. Please advise me if the below mentioned providers are enrolled with Tricare. Because the providers are showing on provider portal but not all three locations. I wanted to add their additional locations.  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-03-29 09:30:15', '2021-03-29 09:30:15'),
(12139, 3040, 19987, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  > Good Morning,  Please provide a credentialing application for both providers: Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Respectfully, Katherine Moten TRICARE Community Liaison II Humana', NULL, NULL, '2021-03-29 09:32:11', '2021-03-29 09:32:11'),
(12140, 3040, 19987, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of the request in the Tricare for our group Valley Med Urgent Care PLLC under below locations. Can you please send me the effective date for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis (Still not showing on portal) Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero (Showing in all three location with NOT REQUIRED Status) Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego (Showing on portal in all three locations) (Need Effective Date) Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa (Not showing on provider portal) Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 12:23:34', '2021-04-15 12:23:34'),
(12141, 3040, 19987, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:13:02', '2021-06-01 09:13:02'),
(12142, 3040, 19987, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Please find the attached provider credentialing application form along with the documents as per you previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-03 14:54:15', '2021-06-03 14:54:15'),
(12143, 3040, 19987, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:45:37', '2021-06-21 10:45:37'),
(12144, 3040, 19987, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:48:56', '2021-06-21 10:48:56'),
(12145, 3040, 19987, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-09 11:19:03', '2021-07-09 11:19:03'),
(12146, 3040, 19987, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Karherine,   Hope you are doing well. Please find attached screenshot from Tricare provider portal for Garcia Homero and it\'s showing the \"Action Needed\". Can you please check & advise. Also I wanted to know the enrollment status for the another provider in Tricare under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero (Showing on Provider portal \"Action Needed\") Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego (Advise the enrollment status) Provider NPI# 1568929800  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 15:25:37', '2021-09-09 15:25:37'),
(12147, 10057, 19987, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:46', '2021-10-21 15:27:46'),
(12148, 10057, 19987, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From: ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Morning Steve,  Jacqueline Trenz can assist you with your request.    Brownsville and McAllen Texas is not in my area.  Thanks, Yvonne W. Wyatt,  Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-11-23 17:35:37', '2021-11-23 17:35:37'),
(12149, 10057, 19987, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Yvonne,  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-01 16:24:38', '2021-12-01 16:24:38');
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
(12150, 10057, 19987, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello Jacqueline,  Hope this email finds you well. Could you please check and confirm once again, since I\'m unable to find the below mentioned providers on the Humana - Tricare directory.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Juan Hernandez	1225617558 Jeniece K Wert	1659919702 Homero Garcia	1730564857  Juan Hernandez we are still in contact to get his Malpractice.  Jeniece K Wert not showing for secondary and tertiary locations - previous email you have mentioned to fill out the roster, but there is no file attached.  Homero Garcia not showing in the directory.   Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 11:52:01', '2021-12-08 11:52:01'),
(12151, 10057, 19987, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Greetings!  Hope you are doing well. Can I get a quick response to the below mentioned request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 13:39:41', '2021-12-14 13:39:41'),
(12152, 10057, 19987, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Hello,  Any update on the below request. This is my SECOND REMINDER. Please get back to me with the latest update ASAP.  Regards,', NULL, NULL, '2021-12-21 13:39:45', '2021-12-21 13:39:45'),
(12153, 10057, 19987, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,  1) Juan Hernandez - We cannot move further on his application due to not having received his malpractice insurance certificate. Please see below.  2) Jeniece Wert – please see the attached Provider Roster to submit a request, to add a secondary & tertiary location.  Please email to HGBProviderRosters@humana.com.  3) Homero Garcia – provider profile is complete.  I have submitted a request to my data team to update the directory.  Thank you,  Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-12-28 15:29:36', '2021-12-28 15:29:36'),
(12154, 20067, 19987, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Enrollment Query || Valley Med Urgent Care PLLC || Provider || Tricare ||  Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations. If any provider is enrolled kindly send me the welcome letter.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Nubia Olivama Benavides	1801371935 Edna Michi	1992293906 Garcia Homero	1730564857 Wert Jeniece	1659919702 Juan Hernandez	1225617558   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:09:39', '2022-01-05 17:09:39'),
(12155, 20067, 19987, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East', NULL, NULL, '2022-01-13 16:36:28', '2022-01-13 16:36:28'),
(12156, 20067, 19987, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon, Thanks for the update. Can you please provide me with their welcome kits?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-13 16:41:02', '2022-01-13 16:41:02'),
(12157, 20067, 19987, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad ', NULL, NULL, '2022-01-18 14:09:58', '2022-01-18 14:09:58'),
(12158, 20067, 19987, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Morning Jacqueline!  Hope all is well with you. Can you please provide me with the welcome kits for:  Homero Garcia NPI 1730564857 Teresa Saavedra NPI 1255676151  And also, I would like to know the enrollment status of the mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan hernandez	1225617558 jeniece Wert	1659919702 Nubia Olivama Benavides	1801371935 Edna Michi	1992293906  Thanks & regards, Syed Ahad', NULL, NULL, '2022-02-04 14:26:31', '2022-02-04 14:26:31'),
(12159, 20067, 19987, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good afternoon,     TRICARE does not send Welcome Kits or Letters.     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE', NULL, NULL, '2022-02-16 17:30:47', '2022-02-16 17:30:47'),
(12160, 20067, 19987, NULL, '2022-03-09 00:00:00.000', 'Approved', 'Email received from: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   ood afternoon,     Final status information on  Homero Garcia NPI 1730564857:  Credentialing approved on 9/28/2021. Provider is network and affiliated to  Valley Med Urgent Care at three locations -  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Final status information on  Teresa Saavedra NPI 1255676151:  Provider has been credentialed since 9/14/2020 due  to prior affiliation.  Provider is network and currently affiliated to  Valley Med Urgent Care at three locations:  2534 Boca Chica Blvd, Brownsville TX.  101 E Expressway 83, Suite 170 McAllen Tx  800 E Alton Gloor Brownsville TX     Thank you,  Jacque Trenz  Health System Consultant  Humana Military TRICARE East   ', NULL, NULL, '2022-03-02 16:39:27', '2022-03-02 16:39:27'),
(12161, 3046, 19988, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:35:39', '2021-03-12 12:35:39'),
(12162, 1006, 19988, NULL, '2021-04-23 00:00:00.000', 'Rejected', 'Wellcare does not cover Fort Bend county as per their enrollment form. ', NULL, NULL, '2021-04-16 12:49:54', '2021-04-16 12:49:54'),
(12163, 11056, 19988, NULL, '2021-08-05 00:00:00.000', 'Revalidation', 'Approval email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   Please see welcome letters and contract.   Let us know if you have any questions.   Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-07-29 14:08:11', '2021-07-29 14:08:11'),
(12164, 11056, 19988, NULL, '2021-08-05 00:00:00.000', 'Revalidated', 'Approval email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   Please see welcome letters and contract.   Let us know if you have any questions.   Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com  Shametria eff date is : 06/18/2021  STEPHANE eff date is : 05/01/2021  Please see the attachment', NULL, NULL, '2021-07-29 14:18:25', '2021-07-29 14:18:25'),
(12165, 3046, 19989, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:35:47', '2021-03-12 12:35:47'),
(12166, 1006, 19989, NULL, '2021-04-23 00:00:00.000', 'Not Eligible', 'Segun is a supervising physician for Stephane, we only enrolled him under Cigna for billing purposes. We can\'t enroll him in any other insurances unless required and given a go-ahead from both Stephane & Segun. ', NULL, NULL, '2021-04-16 10:14:21', '2021-04-16 10:14:21'),
(12167, 3040, 19990, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:35:48', '2021-03-12 12:35:48'),
(12168, 3040, 19990, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:16:27', '2021-03-26 17:16:27'),
(12169, 3040, 19990, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Good Morning Katherine,  Hope you had a great weekend. Please advise me if the below mentioned providers are enrolled with Tricare. Because the providers are showing on provider portal but not all three locations. I wanted to add their additional locations.  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-03-29 09:30:54', '2021-03-29 09:30:54'),
(12170, 3040, 19990, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  > Good Morning,  Please provide a credentialing application for both providers: Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Respectfully, Katherine Moten TRICARE Community Liaison II Humana', NULL, NULL, '2021-03-29 09:32:34', '2021-03-29 09:32:34'),
(12171, 3040, 19990, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of the request in the Tricare for our group Valley Med Urgent Care PLLC under below locations. Can you please send me the effective date for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis (Still not showing on portal) Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero (Showing in all three location with NOT REQUIRED Status) Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego (Showing on portal in all three locations) (Need Effective Date) Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa (Not showing on provider portal) Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 12:16:37', '2021-04-15 12:16:37'),
(12172, 3040, 19990, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:13:07', '2021-06-01 09:13:07'),
(12173, 3040, 19990, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Please find the attached provider credentialing application form along with the documents as per you previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-03 14:55:50', '2021-06-03 14:55:50'),
(12174, 3040, 19990, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:45:55', '2021-06-21 10:45:55'),
(12175, 3040, 19990, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:49:10', '2021-06-21 10:49:10'),
(12176, 3040, 19990, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-09 11:19:08', '2021-07-09 11:19:08'),
(12177, 3040, 19990, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Karherine,   Hope you are doing well. Please find attached screenshot from Tricare provider portal for Garcia Homero and it\'s showing the \"Action Needed\". Can you please check & advise. Also I wanted to know the enrollment status for the another provider in Tricare under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero (Showing on Provider portal \"Action Needed\") Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego (Advise the enrollment status) Provider NPI# 1568929800  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 15:25:41', '2021-09-09 15:25:41'),
(12178, 10057, 19990, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:40', '2021-10-21 15:27:40'),
(12179, 10057, 19990, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556             Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application,  complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558            Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit. NPI 1659919702                 Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800                 Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857                 Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502                 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21   Thank you, Jacque Trenz  Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-11-03 11:36:25', '2021-11-03 11:36:25'),
(12180, 3040, 19991, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:37:25', '2021-03-12 12:37:25'),
(12181, 3040, 19991, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Greetings,   Hope you are doing well.  I wanted to add the providers in the Tricare for our group Valley Med Urgent Care PLLC under below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-03-26 17:16:39', '2021-03-26 17:16:39'),
(12182, 3040, 19991, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  Good Morning Katherine,  Hope you had a great weekend. Please advise me if the below mentioned providers are enrolled with Tricare. Because the providers are showing on provider portal but not all three locations. I wanted to add their additional locations.  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-03-29 09:31:05', '2021-03-29 09:31:05'),
(12183, 3040, 19991, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis,  > Good Morning,  Please provide a credentialing application for both providers: Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Respectfully, Katherine Moten TRICARE Community Liaison II Humana', NULL, NULL, '2021-03-29 09:32:46', '2021-03-29 09:32:46'),
(12184, 3040, 19991, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the status of the request in the Tricare for our group Valley Med Urgent Care PLLC under below locations. Can you please send me the effective date for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis (Still not showing on portal) Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero (Showing in all three location with NOT REQUIRED Status) Provider NPI# 1730564857 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 3: Provider Name: Naranjo, Diego (Showing on portal in all three locations) (Need Effective Date) Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa (Not showing on provider portal) Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 12:16:53', '2021-04-15 12:16:53'),
(12185, 3040, 19991, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Add Location || Valley Med Urgent Care PLLC || Escobar, Angiollet Solis, || Tricare  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166   Group Name: Valley Med Urgent Care PLLC Group NPI#  1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800 Additional Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248   Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Provider NPI# 1255676151 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-06-01 09:13:56', '2021-06-01 09:13:56'),
(12186, 3040, 19991, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Please find the attached provider credentialing application form along with the documents as per you previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-03 14:55:55', '2021-06-03 14:55:55'),
(12187, 3040, 19991, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Both credentialing applications have been submitted for processing. Please allow 90 days for processing.   Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com', NULL, NULL, '2021-06-21 10:45:52', '2021-06-21 10:45:52'),
(12188, 3040, 19991, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. I wanted to add the additional locations for the below mentioned group and providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-21 10:49:05', '2021-06-21 10:49:05'),
(12189, 3040, 19991, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Katherine,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers in the Tricare for our group Valley Med Urgent Care PLLC.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego Provider NPI# 1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-09 11:19:11', '2021-07-09 11:19:11'),
(12190, 3040, 19991, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Tricare ||  Hello Karherine,   Hope you are doing well. Please find attached screenshot from Tricare provider portal for Garcia Homero and it\'s showing the \"Action Needed\". Can you please check & advise. Also I wanted to know the enrollment status for the another provider in Tricare under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC  Practice Tax ID# 81-5123542  Practice NPI# 1518404631  Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496  Secondary Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Tertiary Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Provider 1:  Provider Name: Garcia, Homero (Showing on Provider portal \"Action Needed\") Provider NPI# 1730564857  Provider 2:  Provider Name: Naranjo, Diego (Advise the enrollment status) Provider NPI# 1568929800  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 15:25:44', '2021-09-09 15:25:44'),
(12191, 10057, 19991, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group Valley Med Urgent Care PLLC and provider in Tricare for our group under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Naranjo, Diego	1568929800 Garcia, Homero	1730564857 Lira, Arturo	1245789502  Please get back to me as soon as you have time. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 15:27:29', '2021-10-21 15:27:29'),
(12192, 10057, 19991, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email Received From : jtrenz@humana.com  Sub : Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good morning,  NPI 1700960556             Not certified.  Please visit humanamilitary.com, click on Provider link, click on Forms. Locate appropriate certification application,  complete and fax to WPS at number located on application.  Please allow 90 days for processing  NPI 1225617558            Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice). Please see screenshot below to submit. NPI 1659919702                 Provider credentialing is complete effective 8/31/21. Prov is affiliated with Valley med, 2534 Boca Chica, Brownsville, TX Please use attached Provider Roster to request adding second & third location.  NPI 1568929800                 Prov credentialing complete effect 8/31/21. Prov is affiliated with three locations listed.  NPI 1730564857                 Prov credentialing complete effective 9/28/21. Prov is affiliated with three locations listed.  NPI 1245789502                 Credentialing is on hold. Application is missing the Certificate of Insurance (malpractice) and work history. Email request sent 6/9/21   Thank you, Jacque Trenz  Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-11-03 11:35:25', '2021-11-03 11:35:25'),
(12193, 3040, 19992, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:39:08', '2021-03-12 12:39:08'),
(12194, 3040, 19992, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Hello Diana,   Hope you are doing well. Can you please confirm that provider enrolled in all three locations?  Below are the details:   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 14:22:17', '2021-03-23 14:22:17'),
(12195, 3040, 19992, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good Morning Diana,  Hope you had a great weekend. I checked the Driscoll provider directory online overthere provider is not showing up. Can you please send me a roster showing provider enrolled in all three locations?  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-29 09:18:52', '2021-03-29 09:18:52'),
(12196, 3040, 19992, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good morning Adi,  Provider Angiollett S Escobar is enrolled in all three location listed below.  I hope this helps  ', NULL, NULL, '2021-03-29 09:19:40', '2021-03-29 09:19:40'),
(12197, 3040, 19992, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: 	DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:32:00', '2021-04-13 13:32:00'),
(12198, 3040, 19992, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Provider participating in additional location.  Please see attachment.  ', NULL, NULL, '2021-05-04 13:26:33', '2021-05-04 13:26:33'),
(12199, 3040, 19993, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:39:33', '2021-03-12 12:39:33'),
(12200, 3040, 19993, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:00', '2021-03-23 14:45:00'),
(12201, 3040, 19993, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:52:20', '2021-04-14 10:52:20'),
(12202, 3040, 19993, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:42', '2021-05-28 08:42:42'),
(12203, 3040, 19993, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:01', '2021-06-16 12:41:01'),
(12204, 3040, 19993, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:30', '2021-06-16 12:43:30'),
(12205, 3040, 19993, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:00', '2021-07-05 13:39:00'),
(12206, 3040, 19993, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:01', '2021-07-26 13:38:01'),
(12207, 3040, 19993, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:32', '2021-09-01 15:01:32');
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
(12208, 10057, 19993, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:52', '2021-11-08 14:35:52'),
(12209, 10057, 19993, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:06:19', '2021-12-01 16:06:19'),
(12210, 10057, 19993, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:57:27', '2021-12-14 10:57:27'),
(12211, 10057, 19993, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:29:01', '2021-12-21 10:29:01'),
(12212, 10057, 19993, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:48', '2021-12-28 13:10:48'),
(12213, 20067, 19993, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:30:00', '2022-01-05 13:30:00'),
(12214, 20067, 19993, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:49', '2022-01-18 12:25:49'),
(12215, 20067, 19993, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:02:08', '2022-01-28 18:02:08'),
(12216, 20067, 19993, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:27:43', '2022-02-04 11:27:43'),
(12217, 22077, 19993, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:05:38', '2022-04-07 14:05:38'),
(12218, 3040, 19994, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:39:54', '2021-03-12 12:39:54'),
(12219, 3040, 19994, NULL, '2021-03-30 00:00:00.000', 'Approved', 'Provider enrolled in Driscoll.   Please see attachment.', NULL, NULL, '2021-03-23 15:33:52', '2021-03-23 15:33:52'),
(12220, 3040, 19994, NULL, '2021-09-10 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-09-03 08:52:21', '2021-09-03 08:52:21'),
(12221, 3040, 19994, NULL, '2021-09-10 00:00:00.000', 'Revalidated', 'Email rcvd from: Diane.Vela@dchstx.org  Subject: RE: CREDENTIALING- Eder Hernandez PA  Good afternoon,  He was re-credentialed with a renewal date of 09/01/2021. See attached letter.', NULL, NULL, '2021-09-03 08:53:09', '2021-09-03 08:53:09'),
(12222, 3040, 19995, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:40:14', '2021-03-12 12:40:14'),
(12223, 3040, 19995, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:16', '2021-03-23 14:45:16'),
(12224, 3040, 19995, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:49:43', '2021-04-13 12:49:43'),
(12225, 3040, 19995, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:55:10', '2021-04-13 12:55:10'),
(12226, 3040, 19995, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:48', '2021-05-28 08:42:48'),
(12227, 3040, 19995, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:16', '2021-06-16 12:41:16'),
(12228, 3040, 19995, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:44', '2021-06-16 12:43:44'),
(12229, 3040, 19995, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:09', '2021-07-05 13:39:09'),
(12230, 3040, 19995, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:05', '2021-07-26 13:38:05'),
(12231, 10057, 19995, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra Alejandra	1265945125 Naranjo, Diego	1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks & Regards,', NULL, NULL, '2021-10-05 15:22:11', '2021-10-05 15:22:11'),
(12232, 10057, 19995, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:44', '2021-11-08 14:35:44'),
(12233, 10057, 19995, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:06:10', '2021-12-01 16:06:10'),
(12234, 10057, 19995, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:57:22', '2021-12-14 10:57:22'),
(12235, 10057, 19995, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:56', '2021-12-21 10:28:56'),
(12236, 10057, 19995, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:43', '2021-12-28 13:10:43'),
(12237, 20067, 19995, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:29:00', '2022-01-05 13:29:00'),
(12238, 20067, 19995, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:41', '2022-01-18 12:25:41'),
(12239, 20067, 19995, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:02:02', '2022-01-28 18:02:02'),
(12240, 20067, 19995, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:25:54', '2022-02-04 11:25:54'),
(12241, 3040, 19996, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:40:35', '2021-03-12 12:40:35'),
(12242, 3040, 19996, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:30', '2021-03-23 14:45:30'),
(12243, 3040, 19996, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:52:54', '2021-04-13 12:52:54'),
(12244, 3040, 19996, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Add a provider- DIEGO NARANJO/ ARTURO ALEJANDRO  Good Afternoon,  Diego Naranjo NPI: 1568929800 TIN 815123542 is within Credentialing.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA   ', NULL, NULL, '2021-04-21 07:16:08', '2021-04-21 07:16:08'),
(12245, 3040, 19996, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:52', '2021-05-28 08:42:52'),
(12246, 3040, 19996, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:33', '2021-06-16 12:41:33'),
(12247, 3040, 19996, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:44:00', '2021-06-16 12:44:00'),
(12248, 3040, 19996, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:16', '2021-07-05 13:39:16'),
(12249, 3040, 19996, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:05', '2021-07-26 13:38:05'),
(12250, 3040, 19996, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:37', '2021-09-01 15:01:37'),
(12251, 10057, 19996, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:38', '2021-11-08 14:35:38'),
(12252, 10057, 19996, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:06:01', '2021-12-01 16:06:01'),
(12253, 10057, 19996, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:57:16', '2021-12-14 10:57:16'),
(12254, 10057, 19996, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:48', '2021-12-21 10:28:48'),
(12255, 10057, 19996, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:37', '2021-12-28 13:10:37'),
(12256, 20067, 19996, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:27:44', '2022-01-05 13:27:44'),
(12257, 20067, 19996, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:34', '2022-01-18 12:25:34'),
(12258, 20067, 19996, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:56', '2022-01-28 18:01:56'),
(12259, 20067, 19996, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:25:18', '2022-02-04 11:25:18'),
(12260, 22077, 19996, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:04:47', '2022-04-07 14:04:47'),
(12261, 3040, 19997, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:41:13', '2021-03-12 12:41:13'),
(12262, 3040, 19997, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org, Christine.Rodriguez@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 15:53:39', '2021-03-23 15:53:39'),
(12263, 3040, 19997, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good Morning,   Can you please send me the roster in which it mentioned that the provider is enrolled in 800 E Alton Gloor Blvd in Brownsville TX location. Because I checked the provider on the Driscoll provider directory it\'s not showing up over there. Also can you please send me the contact information for provider representative?  Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-29 09:47:10', '2021-03-29 09:47:10'),
(12264, 3040, 19997, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good morning Adi,  I reviewed Arturo Lira’s account he is only credentialed for the 800 E Alton Gloor Blvd, in Brownsville Texas. Please contact your provider representative to add additional locations  I hope this helps  Sincerely  Diana R. Flores Credentialing Specialist', NULL, NULL, '2021-03-29 09:48:02', '2021-03-29 09:48:02'),
(12265, 3040, 19997, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Martha.Butler@dchstx.org  Subject:  Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  As a follow up to our discussion, I have  attached Request to Credential for Existing Group Form to add the new Providers.  To initiate the verification process return to email box: DHPContracting@dchstx.org.  I have also included your points of contact for future Credentialing inquires.  ·         Anna Bartholomew Credentialing Supervisor Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist Fax: 361-881-1349 Email: karla.claunch@dchstx.org  Do not hesitate to contact me if I may be of further assistance.  Thank You, Martha Butler Provider Relations Representative  ', NULL, NULL, '2021-03-29 09:50:55', '2021-03-29 09:50:55'),
(12266, 3040, 19997, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org Martha.Butler@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello,   I wanted to know the enrollment status for the below mentioned providers for our group in Valley Med Urgent Care PLLC under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-05-28 08:53:20', '2021-05-28 08:53:20'),
(12267, 3040, 19997, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Miguel.Zamora@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  This provider is Active with Driscoll Health Plan but he’s not part of Valley Med Urgent we only have him Active with South Texas Neurosurgery Associates. You would have to request in writing or letter and W-9 to add that provider to Valley Med Urgent Care. If you have any questions, please feel free to contact me or Martha Butler.  Thank you,', NULL, NULL, '2021-06-16 12:57:08', '2021-06-16 12:57:08'),
(12268, 3040, 19997, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,   Hope you are doing well. Please find attached Letter of intent along with the W9 as per requested email to link the provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 13:52:06', '2021-07-05 13:52:06'),
(12269, 3040, 19997, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:49:21', '2021-07-26 13:49:21'),
(12270, 10057, 19997, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra Alejandra	1265945125 Naranjo, Diego	1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks & Regards,', NULL, NULL, '2021-10-05 15:21:46', '2021-10-05 15:21:46'),
(12271, 10057, 19997, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'The provider is no longer in the group.   Please see attachment', NULL, NULL, '2021-11-09 15:19:35', '2021-11-09 15:19:35'),
(12272, 3040, 19998, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:41:45', '2021-03-12 12:41:45');
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
(12273, 3040, 19998, NULL, '2021-03-30 00:00:00.000', 'Approved', 'All the three locations are showing linked with (Driscoll) ', NULL, NULL, '2021-03-23 14:09:44', '2021-03-23 14:09:44'),
(12274, 3040, 19999, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:42:24', '2021-03-12 12:42:24'),
(12275, 3040, 19999, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:06', '2021-03-23 14:45:06'),
(12276, 3040, 19999, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:52:26', '2021-04-14 10:52:26'),
(12277, 3040, 19999, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:41:56', '2021-05-28 08:41:56'),
(12278, 3040, 19999, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:40:55', '2021-06-16 12:40:55'),
(12279, 3040, 19999, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:25', '2021-06-16 12:43:25'),
(12280, 3040, 19999, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:38:45', '2021-07-05 13:38:45'),
(12281, 3040, 19999, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:02', '2021-07-26 13:38:02'),
(12282, 3040, 19999, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:34', '2021-09-01 15:01:34'),
(12283, 10057, 19999, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:32', '2021-11-08 14:35:32'),
(12284, 10057, 19999, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:51', '2021-12-01 16:05:51'),
(12285, 10057, 19999, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:57:10', '2021-12-14 10:57:10'),
(12286, 10057, 19999, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:42', '2021-12-21 10:28:42'),
(12287, 10057, 19999, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:32', '2021-12-28 13:10:32'),
(12288, 20067, 19999, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:29:42', '2022-01-05 13:29:42'),
(12289, 20067, 19999, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:27', '2022-01-18 12:25:27'),
(12290, 20067, 19999, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:51', '2022-01-28 18:01:51'),
(12291, 20067, 19999, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:25:11', '2022-02-04 11:25:11'),
(12292, 22077, 19999, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:05:24', '2022-04-07 14:05:24'),
(12293, 3040, 20000, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:42:44', '2021-03-12 12:42:44'),
(12294, 3040, 20000, NULL, '2021-03-30 00:00:00.000', 'Approved', 'Provider enrolled in Driscoll.   Please see attachment.', NULL, NULL, '2021-03-23 15:33:47', '2021-03-23 15:33:47'),
(12295, 1006, 20000, NULL, '2021-08-11 00:00:00.000', 'Revalidation', 'Received the following request from Diane.Vela@dchstx.org:  Sub: CREDENTIALING- Eder Hernandez PA  \"Eder Hernandez PA NPI:  1386956852 Valley Med Urgent Care PLLC Tax ID:  81-5123542  Good morning,  Can you please complete the following for re-credentialing with the above group?  ·         Addendum ·         Prescriptive Authority Agreement  You may submit to me via email or fax.  Thank you,  Diane S. Vela Credentialing Specialist 4525 Ayers St Corpus Christi, TX 78415-1401 Office:  (361) 694-6282 Fax: (361) 808-2182 Email: diane.vela@dchstx.org Website: www.driscollhealthplan.com\"  Replied with: \"Hello Diane,   Please find the following information as requested. Do let me know if you have any questions.  Thank you. \"  ', NULL, NULL, '2021-08-04 16:54:32', '2021-08-04 16:54:32'),
(12296, 3040, 20000, NULL, '2021-09-08 00:00:00.000', 'Revalidation', 'Email sent to: Diane.Vela@dchstx.org  Subject: Re: CREDENTIALING- Eder Hernandez PA  Hello Daine,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group under the below locations.   Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501 Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526  Provider Name: Hernandez, Eder Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-01 14:39:30', '2021-09-01 14:39:30'),
(12297, 3040, 20000, NULL, '2021-09-10 00:00:00.000', 'Revalidated', 'Email rcvd from: Diane.Vela@dchstx.org  Subject: RE: CREDENTIALING- Eder Hernandez PA  Good afternoon,  He was re-credentialed with a renewal date of 09/01/2021. See attached letter.', NULL, NULL, '2021-09-03 08:52:55', '2021-09-03 08:52:55'),
(12298, 3040, 20001, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:43:01', '2021-03-12 12:43:01'),
(12299, 3040, 20001, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:21', '2021-03-23 14:45:21'),
(12300, 3040, 20001, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:49:47', '2021-04-13 12:49:47'),
(12301, 3040, 20001, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:55:15', '2021-04-13 12:55:15'),
(12302, 3040, 20001, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:01', '2021-05-28 08:42:01'),
(12303, 3040, 20001, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:11', '2021-06-16 12:41:11'),
(12304, 3040, 20001, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:39', '2021-06-16 12:43:39'),
(12305, 3040, 20001, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:02', '2021-07-05 13:39:02'),
(12306, 3040, 20001, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:04', '2021-07-26 13:38:04'),
(12307, 10057, 20001, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra Alejandra	1265945125 Naranjo, Diego	1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks & Regards,', NULL, NULL, '2021-10-05 15:21:27', '2021-10-05 15:21:27'),
(12308, 10057, 20001, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:26', '2021-11-08 14:35:26'),
(12309, 10057, 20001, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:41', '2021-12-01 16:05:41'),
(12310, 10057, 20001, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:57:05', '2021-12-14 10:57:05'),
(12311, 10057, 20001, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:36', '2021-12-21 10:28:36'),
(12312, 10057, 20001, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:26', '2021-12-28 13:10:26'),
(12313, 20067, 20001, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:28:44', '2022-01-05 13:28:44'),
(12314, 20067, 20001, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:20', '2022-01-18 12:25:20'),
(12315, 20067, 20001, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:44', '2022-01-28 18:01:44'),
(12316, 20067, 20001, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:25:04', '2022-02-04 11:25:04'),
(12317, 3040, 20002, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:43:19', '2021-03-12 12:43:19'),
(12318, 3040, 20002, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:34', '2021-03-23 14:45:34'),
(12319, 3040, 20002, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:53:00', '2021-04-13 12:53:00'),
(12320, 3040, 20002, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Add a provider- DIEGO NARANJO/ ARTURO ALEJANDRO  Good Afternoon,  Diego Naranjo NPI: 1568929800 TIN 815123542 is within Credentialing.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA   ', NULL, NULL, '2021-04-21 07:16:03', '2021-04-21 07:16:03'),
(12321, 3040, 20002, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:05', '2021-05-28 08:42:05'),
(12322, 3040, 20002, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:29', '2021-06-16 12:41:29'),
(12323, 3040, 20002, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:58', '2021-06-16 12:43:58'),
(12324, 3040, 20002, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:11', '2021-07-05 13:39:11'),
(12325, 3040, 20002, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:07', '2021-07-26 13:38:07'),
(12326, 3040, 20002, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:37', '2021-09-01 15:01:37'),
(12327, 10057, 20002, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:20', '2021-11-08 14:35:20'),
(12328, 10057, 20002, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:33', '2021-12-01 16:05:33'),
(12329, 10057, 20002, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:59', '2021-12-14 10:56:59'),
(12330, 10057, 20002, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:31', '2021-12-21 10:28:31'),
(12331, 10057, 20002, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:21', '2021-12-28 13:10:21'),
(12332, 20067, 20002, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:27:31', '2022-01-05 13:27:31'),
(12333, 20067, 20002, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:10', '2022-01-18 12:25:10'),
(12334, 20067, 20002, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:38', '2022-01-28 18:01:38');
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
(12335, 20067, 20002, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:24:10', '2022-02-04 11:24:10'),
(12336, 22077, 20002, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:04:28', '2022-04-07 14:04:28'),
(12337, 3040, 20003, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:43:54', '2021-03-12 12:43:54'),
(12338, 3040, 20003, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org, Christine.Rodriguez@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 15:53:44', '2021-03-23 15:53:44'),
(12339, 3040, 20003, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good Morning,   Can you please send me the roster in which it mentioned that the provider is enrolled in 800 E Alton Gloor Blvd in Brownsville TX location. Because I checked the provider on the Driscoll provider directory it\'s not showing up over there. Also can you please send me the contact information for provider representative?  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-29 09:47:16', '2021-03-29 09:47:16'),
(12340, 3040, 20003, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good morning Adi,  I reviewed Arturo Lira’s account he is only credentialed for the 800 E Alton Gloor Blvd, in Brownsville Texas. Please contact your provider representative to add additional locations  I hope this helps  Sincerely  Diana R. Flores Credentialing Specialist', NULL, NULL, '2021-03-29 09:48:07', '2021-03-29 09:48:07'),
(12341, 3040, 20003, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Martha.Butler@dchstx.org  Subject:  Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  As a follow up to our discussion, I have  attached Request to Credential for Existing Group Form to add the new Providers.  To initiate the verification process return to email box: DHPContracting@dchstx.org.  I have also included your points of contact for future Credentialing inquires.  ·         Anna Bartholomew Credentialing Supervisor Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist Fax: 361-881-1349 Email: karla.claunch@dchstx.org  Do not hesitate to contact me if I may be of further assistance.  Thank You, Martha Butler Provider Relations Representative  ', NULL, NULL, '2021-03-29 09:51:00', '2021-03-29 09:51:00'),
(12342, 3040, 20003, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org Martha.Butler@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello,   I wanted to know the enrollment status for the below mentioned providers for our group in Valley Med Urgent Care PLLC under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-05-28 08:53:01', '2021-05-28 08:53:01'),
(12343, 3040, 20003, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Miguel.Zamora@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  This provider is Active with Driscoll Health Plan but he’s not part of Valley Med Urgent we only have him Active with South Texas Neurosurgery Associates. You would have to request in writing or letter and W-9 to add that provider to Valley Med Urgent Care. If you have any questions, please feel free to contact me or Martha Butler.  Thank you,', NULL, NULL, '2021-06-16 12:57:03', '2021-06-16 12:57:03'),
(12344, 3040, 20003, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,   Hope you are doing well. Please find attached Letter of intent along with the W9 as per requested email to link the provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 13:52:00', '2021-07-05 13:52:00'),
(12345, 3040, 20003, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:49:22', '2021-07-26 13:49:22'),
(12346, 1006, 20003, NULL, '2021-08-11 00:00:00.000', 'Not Eligible', 'The provider is no longer in the group. ', NULL, NULL, '2021-08-04 16:05:22', '2021-08-04 16:05:22'),
(12347, 3040, 20004, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:44:21', '2021-03-12 12:44:21'),
(12348, 3040, 20004, NULL, '2021-03-30 00:00:00.000', 'Approved', 'All the three locations are showing linked with (Driscoll) ', NULL, NULL, '2021-03-23 14:09:51', '2021-03-23 14:09:51'),
(12349, 3040, 20005, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:44:52', '2021-03-12 12:44:52'),
(12350, 3040, 20005, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Hello Diana,   Hope you are doing well. Can you please confirm that provider enrolled in all three locations?  Below are the details:   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 14:22:24', '2021-03-23 14:22:24'),
(12351, 3040, 20005, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good Morning Diana,  Hope you had a great weekend. I checked the Driscoll provider directory online overthere provider is not showing up. Can you please send me a roster showing provider enrolled in all three locations?  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-29 09:18:57', '2021-03-29 09:18:57'),
(12352, 3040, 20005, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: CREDENTIALING-Angiollet S Escobar NP  Good morning Adi,  Provider Angiollett S Escobar is enrolled in all three location listed below.  I hope this helps  ', NULL, NULL, '2021-03-29 09:19:45', '2021-03-29 09:19:45'),
(12353, 3040, 20005, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: 	DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:32:05', '2021-04-13 13:32:05'),
(12354, 3040, 20005, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Provider participating in additional location.  Please see attachment.  ', NULL, NULL, '2021-05-04 13:26:37', '2021-05-04 13:26:37'),
(12355, 3040, 20006, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:45:12', '2021-03-12 12:45:12'),
(12356, 3040, 20006, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:11', '2021-03-23 14:45:11'),
(12357, 3040, 20006, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:52:32', '2021-04-14 10:52:32'),
(12358, 3040, 20006, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:25', '2021-05-28 08:42:25'),
(12359, 3040, 20006, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:40:50', '2021-06-16 12:40:50'),
(12360, 3040, 20006, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:24', '2021-06-16 12:43:24'),
(12361, 3040, 20006, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:38:58', '2021-07-05 13:38:58'),
(12362, 3040, 20006, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:03', '2021-07-26 13:38:03'),
(12363, 3040, 20006, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:34', '2021-09-01 15:01:34'),
(12364, 10057, 20006, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:14', '2021-11-08 14:35:14'),
(12365, 10057, 20006, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:24', '2021-12-01 16:05:24'),
(12366, 10057, 20006, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:53', '2021-12-14 10:56:53'),
(12367, 10057, 20006, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:24', '2021-12-21 10:28:24'),
(12368, 10057, 20006, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:15', '2021-12-28 13:10:15'),
(12369, 20067, 20006, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:29:30', '2022-01-05 13:29:30'),
(12370, 20067, 20006, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:25:01', '2022-01-18 12:25:01'),
(12371, 20067, 20006, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:32', '2022-01-28 18:01:32'),
(12372, 20067, 20006, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:24:03', '2022-02-04 11:24:03'),
(12373, 22077, 20006, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:05:55', '2022-04-07 14:05:55'),
(12374, 3040, 20007, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:45:32', '2021-03-12 12:45:32'),
(12375, 3040, 20007, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Hernandez, Eder Francisco || Driscoll||  Greetings,   Hope you are doing well. I wanted to add the providers in the Driscoll Health plan for our group Valley Med Urgent Care PLLC under below locations.  Provider 2:   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Practice Address: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 15:38:43', '2021-03-23 15:38:43'),
(12376, 3040, 20007, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Dominque.silva@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Hernandez, Eder Francisco || Driscoll||  Good Morning Dominque,   I wanted to add the provider in the Driscoll Health plan for our group Valley Med Urgent Care PLLC under below location.  Provider 1:   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 10:05:35', '2021-03-29 10:05:35'),
(12377, 3040, 20007, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Hernandez, Eder Francisco || Driscoll||  Good morning,  Dominque Silva is our Director of Provider Relations Email address: Dominque.silva@dchstx.org Phone: 956-632-8313  ', NULL, NULL, '2021-03-29 10:06:25', '2021-03-29 10:06:25'),
(12378, 3040, 20007, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Hernandez, Eder Francisco || Driscoll||  Good morning,   Can you please send me the provider representative info?  Thank you ', NULL, NULL, '2021-03-29 10:06:59', '2021-03-29 10:06:59'),
(12379, 3040, 20007, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Hernandez, Eder Francisco || Driscoll||  Good morning Adi,  Please contact provider Representative to add new providers.  Thank you  Sincerely  Diana R. Flores', NULL, NULL, '2021-03-29 10:07:35', '2021-03-29 10:07:35'),
(12380, 3040, 20007, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:35:11', '2021-04-13 13:35:11'),
(12381, 3040, 20007, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Provider enrolled in Driscoll.   Please see attachment.', NULL, NULL, '2021-04-15 15:23:20', '2021-04-15 15:23:20'),
(12382, 3040, 20007, NULL, '2021-09-10 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-09-03 08:52:59', '2021-09-03 08:52:59'),
(12383, 3040, 20007, NULL, '2021-09-10 00:00:00.000', 'Revalidated', 'Email rcvd from: Diane.Vela@dchstx.org  Subject: RE: CREDENTIALING- Eder Hernandez PA  Good afternoon,  He was re-credentialed with a renewal date of 09/01/2021. See attached letter.', NULL, NULL, '2021-09-03 08:53:13', '2021-09-03 08:53:13'),
(12384, 3040, 20008, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:45:48', '2021-03-12 12:45:48'),
(12385, 3040, 20008, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:25', '2021-03-23 14:45:25'),
(12386, 3040, 20008, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:49:52', '2021-04-13 12:49:52'),
(12387, 3040, 20008, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:55:19', '2021-04-13 12:55:19'),
(12388, 3040, 20008, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:29', '2021-05-28 08:42:29'),
(12389, 3040, 20008, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:06', '2021-06-16 12:41:06'),
(12390, 3040, 20008, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:35', '2021-06-16 12:43:35'),
(12391, 3040, 20008, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:06', '2021-07-05 13:39:06'),
(12392, 3040, 20008, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:03', '2021-07-26 13:38:03'),
(12393, 10057, 20008, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra Alejandra	1265945125 Naranjo, Diego	1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks & Regards,', NULL, NULL, '2021-10-05 15:22:41', '2021-10-05 15:22:41'),
(12394, 10057, 20008, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:08', '2021-11-08 14:35:08'),
(12395, 10057, 20008, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:14', '2021-12-01 16:05:14'),
(12396, 10057, 20008, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:48', '2021-12-14 10:56:48'),
(12397, 10057, 20008, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:16', '2021-12-21 10:28:16'),
(12398, 10057, 20008, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:10:08', '2021-12-28 13:10:08'),
(12399, 20067, 20008, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:28:12', '2022-01-05 13:28:12'),
(12400, 20067, 20008, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:24:53', '2022-01-18 12:24:53'),
(12401, 20067, 20008, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:27', '2022-01-28 18:01:27');
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
(12402, 20067, 20008, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:23:56', '2022-02-04 11:23:56'),
(12403, 3040, 20009, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:46:08', '2021-03-12 12:46:08'),
(12404, 3040, 20009, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Garcia, Homero, Lopez, Mayra Alejandra & Naranjo, Diego || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-23 14:45:39', '2021-03-23 14:45:39'),
(12405, 3040, 20009, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached request for credentialing for below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-13 12:53:03', '2021-04-13 12:53:03'),
(12406, 3040, 20009, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Add a provider- DIEGO NARANJO/ ARTURO ALEJANDRO  Good Afternoon,  Diego Naranjo NPI: 1568929800 TIN 815123542 is within Credentialing.  Please allow additional time to process and feel free to proceed requesting status updates.  Respectfully,  Daniel Velez Provider Account Manager, Region 4 - Provider Relations Hidalgo SDA   ', NULL, NULL, '2021-04-21 07:15:58', '2021-04-21 07:15:58'),
(12407, 3040, 20009, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org, martha.butler@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-05-28 08:42:34', '2021-05-28 08:42:34'),
(12408, 3040, 20009, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  This location is within our service area.  Please send a Request for Contract, along with the addendum and disclosure statement, for each provider/each location who will be practicing under it.  Please also include a current W9 when responding.  Thankyou  Karla Claunch      ', NULL, NULL, '2021-06-16 12:41:24', '2021-06-16 12:41:24'),
(12409, 3040, 20009, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: 	Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. Please find the attached request for contract along with addendum and disclosure statement for the below mentioned providers as per your above email requested.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 12:43:49', '2021-06-16 12:43:49'),
(12410, 3040, 20009, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Greetings Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Garcia, Homero Provider NPI#  1730564857  Provider 2: Provider Name: Lopez, Mayra Alejandra Provider NPI#  1265945125  Provider 3: Provider Name: Naranjo, Diego Provider NPI#  1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-07-05 13:39:14', '2021-07-05 13:39:14'),
(12411, 3040, 20009, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: RE: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon Adil,  These providers are all still in process.', NULL, NULL, '2021-07-26 13:38:08', '2021-07-26 13:38:08'),
(12412, 3040, 20009, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject; Re: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166       Provider 1: Provider Name: Garcia, Homero                     Provider NPI#  1730564857  Provider 2: Provider Name: Naranjo, Diego                      Provider NPI#  1568929800    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you  ', NULL, NULL, '2021-09-01 15:01:37', '2021-09-01 15:01:37'),
(12413, 10057, 20009, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  I don’t know what was missing or needed,  I’m only able to see that they were withdrawn for lack of response.  You are welcome to resubmit the requests and I can run them through again.  It is very important that the CAQH is current and accurate with special attention to practice address/information and contact person information.   We are required to send all credentialing through Aperture so, if someone from Aperture needs to request additional information, they will be able to contact the correct person.  They will also be looking for the practice information to match our request.   Once we get the records from Aperture, someone from our credentialing department may need to obtain additional information and a very prompt response is needed due to time limitations in processing.  If you would like to send the requests again, please also include the attached, additional documents for each of them.  You are welcome to send them directly to me and I will be glad to get them started again.  Since they are mid-level practitioners, we will also need a current PAA or Collaborative agreement for them.  Please let me know if you need any further assistance.  I look forward to hearing from you soon.  Karla Claunch    ', NULL, NULL, '2021-11-08 14:35:01', '2021-11-08 14:35:01'),
(12414, 10057, 20009, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:05:05', '2021-12-01 16:05:05'),
(12415, 10057, 20009, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Waiting for PAA and Collaborative agreement - reminder sent to Alex', NULL, NULL, '2021-12-14 10:56:43', '2021-12-14 10:56:43'),
(12416, 10057, 20009, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing great. Please see the attached documents for the credentialing process for the below mentioned providers.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra	1265945125 Naranjo, Diego	1568929800  Let me know if you have any questions.  Thanks & Regards,', NULL, NULL, '2021-12-21 10:28:09', '2021-12-21 10:28:09'),
(12417, 10057, 20009, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon,  Thank you for these, I will hold them for their records however, we will need a Request for Contract(attached) for each provider.   There is a PAA attached for Juan Alonso Hernandez, we have no records of this provider and will also need his addendum and disclosure along with the Request for Contract.   The other PAA attached was for Homero Garcia but, we will also need one for each of the NP/PA providers.   You can send all of these documents directly to me when you’re ready.   At this time, I’m not able to start processing any of these providers without the requests but, I look forward to working with these as soon as I hear back from you.  Thank you', NULL, NULL, '2021-12-28 13:09:58', '2021-12-28 13:09:58'),
(12418, 20067, 20009, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Good Afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers under these locations.  Group Name	Valley Med Urgent Care PLLC Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd, Brownsville, TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd, Brownsville, TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170, McAllen, TX 78501-1166 Provider Name	NPI Juan Hernandez	1225617558 Diego Naranjo	1568929800 Homero García	1730564857 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 13:27:15', '2022-01-05 13:27:15'),
(12419, 20067, 20009, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||   Please see my comments in the table added to the right     Juan Hernandez  1225617558  No records of this provider  Diego Naranjo  1568929800  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Homero García  1730564857  8/13/2021 Application withdrawn due to Incomplete/Non-Response  Mayra Lopez  1265945125  7/26/2021 Application withdrawn due to Incomplete/Non-Response', NULL, NULL, '2022-01-18 12:24:44', '2022-01-18 12:24:44'),
(12420, 20067, 20009, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Good afternoon, Hope this email finds you well. Can you please tell me what information insurance is asking for these providers and also please tell me the procedure.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-28 18:01:19', '2022-01-28 18:01:19'),
(12421, 20067, 20009, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub:  Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Juan, Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello,  I don’t know what they were missing but, they will need to start the process over again since these were withdrawn.  It is important to make sure their CAQH is current, complete and accurate.  It is also very important to make sure the practice and contact person information are correct and all current documents are loaded to their CAQH records.  You must respond to Apertutre/Verisys and our credentialing specialists when they attempt contact to retrieve additional information.  All of this will prevent delays and/or withdrawal.   When sending in the Request for Contract, also include the additional, attached documents and a PAA or Collaborative agreement for NP’s or PA’s.  Email to dhpcontracting@dchstx.org  Our inbox cannot open encrypted emails.  If you are unable to send unencrypted emails, you can send everything directly to me but, please don’t send to both.', NULL, NULL, '2022-02-04 11:23:50', '2022-02-04 11:23:50'),
(12422, 22077, 20009, NULL, '2022-04-14 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  subject: Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego & Garcia, Homero || Driscoll ||  Hi Karla,  Hope you are doing well. I would like to know the enrollment process for the following providers  Group Name: Valley Med Urgent Care PLLC Tax ID: 81-5123542 Group NPI: 1518404631 Primary Location:  2534 Boca Chica Blvd Brownsville, TX 78521-3496 Secondary Location: 800 E Alton Gloor Blvd Brownsville, TX 78526-4248 Tertiary Location: 101 E. Expressway 83, Suite #170 McAllen, TX 78501-1166 Provider Name	NPI Naranjo, Diego	1568929800 Garcia, Homero	1730564857  Looking forward to your kind response. Have a great day!  Thanks & Regards.', NULL, NULL, '2022-04-07 14:05:05', '2022-04-07 14:05:05'),
(12423, 3040, 20010, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:47:00', '2021-03-12 12:47:00'),
(12424, 3040, 20010, NULL, '2021-03-30 00:00:00.000', 'Initiated', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org, Christine.Rodriguez@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll for our group Valley Med Urgent Care PLLC in all three locations.   Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 15:53:48', '2021-03-23 15:53:48'),
(12425, 3040, 20010, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good Morning,   Can you please send me the roster in which it mentioned that the provider is enrolled in 800 E Alton Gloor Blvd in Brownsville TX location. Because I checked the provider on the Driscoll provider directory it\'s not showing up over there. Also can you please send me the contact information for provider representative?  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-29 09:47:22', '2021-03-29 09:47:22'),
(12426, 3040, 20010, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good morning Adi,  I reviewed Arturo Lira’s account he is only credentialed for the 800 E Alton Gloor Blvd, in Brownsville Texas. Please contact your provider representative to add additional locations  I hope this helps  Sincerely  Diana R. Flores Credentialing Specialist', NULL, NULL, '2021-03-29 09:48:12', '2021-03-29 09:48:12'),
(12427, 3040, 20010, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Martha.Butler@dchstx.org  Subject:  Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  As a follow up to our discussion, I have  attached Request to Credential for Existing Group Form to add the new Providers.  To initiate the verification process return to email box: DHPContracting@dchstx.org.  I have also included your points of contact for future Credentialing inquires.  ·         Anna Bartholomew Credentialing Supervisor Office:  (361) 694-6929 Fax: (361) 808-2182 Email: Anna.Bartholomew@dchstx.org  Karla Claunch, C.M.A. Driscoll Health Plan Provider Contracting and Credentialing Intake Specialist Fax: 361-881-1349 Email: karla.claunch@dchstx.org  Do not hesitate to contact me if I may be of further assistance.  Thank You, Martha Butler Provider Relations Representative  ', NULL, NULL, '2021-03-29 09:51:05', '2021-03-29 09:51:05'),
(12428, 3040, 20010, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org Martha.Butler@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello,   I wanted to know the enrollment status for the below mentioned providers for our group in Valley Med Urgent Care PLLC under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks  ', NULL, NULL, '2021-05-28 08:53:12', '2021-05-28 08:53:12'),
(12429, 3040, 20010, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: Miguel.Zamora@dchstx.org  Subject: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Good afternoon Adil,  This provider is Active with Driscoll Health Plan but he’s not part of Valley Med Urgent we only have him Active with South Texas Neurosurgery Associates. You would have to request in writing or letter and W-9 to add that provider to Valley Med Urgent Care. If you have any questions, please feel free to contact me or Martha Butler.  Thank you,', NULL, NULL, '2021-06-16 12:56:57', '2021-06-16 12:56:57'),
(12430, 3040, 20010, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,   Hope you are doing well. Please find attached Letter of intent along with the W9 as per requested email to link the provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 13:52:03', '2021-07-05 13:52:03'),
(12431, 3040, 20010, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Miguel.Zamora@dchstx.org  Subject: Re: Need to Enroll Provider || Valley Med Urgent Care PLLC || Lira, Arturo Alejandro || Driscoll ||  Hello Miguel & Martha,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Driscoll for our group Valley Med Urgent Care under the below locations.   Practice Detail: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI#  1245789502  Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-26 13:49:23', '2021-07-26 13:49:23'),
(12432, 10057, 20010, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email Sent To : Karla.Claunch@dchstx.org  Sub : Enroll Providers || Valley Med Urgent Care PLLC || Naranjo, Diego, Garcia, Homero & Lopez, Mayra Alejandra || Driscoll ||  Hello Karla,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Driscoll for our group Valley Med Urgent Care PLLC under the below locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Provider Name	NPI Garcia, Homero	1730564857 Lopez, Mayra Alejandra	1265945125 Naranjo, Diego	1568929800  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks & Regards,', NULL, NULL, '2021-10-05 15:22:26', '2021-10-05 15:22:26'),
(12433, 10057, 20010, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'The provider is no longer in the group.   Please see attachment', NULL, NULL, '2021-11-09 15:19:54', '2021-11-09 15:19:54'),
(12434, 3046, 20011, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:47:50', '2021-03-12 12:47:50'),
(12435, 1006, 20011, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'The provider does not need to be enrolled separately with Aetna, unless specified by the insurance as they are only a supervising physician. ', NULL, NULL, '2021-06-04 14:34:29', '2021-06-04 14:34:29'),
(12436, 3040, 20012, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:48:03', '2021-03-12 12:48:03'),
(12437, 3040, 20012, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:52:12', '2021-03-26 14:52:12'),
(12438, 3040, 20012, 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 10:44:23', '2021-04-26 10:44:23'),
(12439, 3040, 20012, 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 09:09:56', '2021-05-31 09:09:56'),
(12440, 3046, 20013, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:48:19', '2021-03-12 12:48:19'),
(12441, 1006, 20013, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Widow, Shuntell M\" shuntell.widow@aetna.com and also called Aetna:  Sub: [SEND SECURE] Aetna General Business #NAF413559  \"Hello Shuntell M,   Could you please send us the contract again as there is no message or attachment listed on the email?  Thank you. \"', NULL, NULL, '2021-06-04 14:47:22', '2021-06-04 14:47:22'),
(12442, 1006, 20013, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The copy of the executed urgentcare contract has been received and is attached for reference in the main group tasks. Both the locations are added under the group. Ref# 6023635857', NULL, NULL, '2021-06-09 09:32:00', '2021-06-09 09:32:00'),
(12443, 3046, 20014, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:48:37', '2021-03-12 12:48:37'),
(12444, 1006, 20014, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent a f/u email @ \"Widow, Shuntell M\" shuntell.widow@aetna.com and also called Aetna:  Sub: [SEND SECURE] Aetna General Business #NAF413559  \"Hello Shuntell M,   Could you please send us the contract again as there is no message or attachment listed on the email?  Thank you. \"', NULL, NULL, '2021-06-04 14:47:34', '2021-06-04 14:47:34'),
(12445, 1006, 20014, NULL, '2021-06-16 00:00:00.000', 'Approved', 'The copy of the executed urgentcare contract has been received and is attached for reference in the main group tasks. Both the locations are added under the group. Ref# 6023635857', NULL, NULL, '2021-06-09 09:31:52', '2021-06-09 09:31:52'),
(12446, 3040, 20015, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:48:51', '2021-03-12 12:48:51'),
(12447, 3040, 20015, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:54:07', '2021-03-26 14:54:07'),
(12448, 3040, 20015, 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 10:45:30', '2021-04-26 10:45:30'),
(12449, 3040, 20015, 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 09:09:59', '2021-05-31 09:09:59'),
(12450, 3040, 20016, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:49:11', '2021-03-12 12:49:11'),
(12451, 3040, 20016, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:56:25', '2021-03-26 14:56:25'),
(12452, 3040, 20016, 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 10:45:13', '2021-04-26 10:45:13'),
(12453, 3040, 20016, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:16:04', '2021-04-26 11:16:04'),
(12454, 3040, 20017, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:49:44', '2021-03-12 12:49:44'),
(12455, 3040, 20017, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:58:13', '2021-03-26 14:58:13'),
(12456, 3040, 20017, 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 10:45:04', '2021-04-26 10:45:04'),
(12457, 3040, 20017, 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 09:10:07', '2021-05-31 09:10:07'),
(12458, 3040, 20018, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:50:22', '2021-03-12 12:50:22'),
(12459, 3040, 20018, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:59:12', '2021-03-26 14:59:12'),
(12460, 3040, 20018, 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 10:40:50', '2021-04-26 10:40:50'),
(12461, 3040, 20018, NULL, NULL, 'Revalidated', '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 10:46:37', '2021-04-26 10:46:37'),
(12462, 3040, 20019, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:51:34', '2021-03-12 12:51:34'),
(12463, 3040, 20019, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:52:17', '2021-03-26 14:52:17'),
(12464, 3040, 20019, 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 10:44:15', '2021-04-26 10:44:15'),
(12465, 3040, 20019, 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 09:08:18', '2021-05-31 09:08:18'),
(12466, 3040, 20020, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:51:56', '2021-03-12 12:51:56'),
(12467, 3040, 20020, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:54:13', '2021-03-26 14:54:13'),
(12468, 3040, 20020, 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 10:45:25', '2021-04-26 10:45:25'),
(12469, 3040, 20020, 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 09:08:21', '2021-05-31 09:08:21'),
(12470, 3040, 20021, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:52:27', '2021-03-12 12:52:27'),
(12471, 3040, 20021, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:58:18', '2021-03-26 14:58:18'),
(12472, 3040, 20021, 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 10:44:56', '2021-04-26 10:44:56'),
(12473, 3040, 20021, 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 09:08:24', '2021-05-31 09:08:24'),
(12474, 3046, 20022, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:52:41', '2021-03-12 12:52:41'),
(12475, 1006, 20022, NULL, '2021-05-12 00:00:00.000', 'Approved', 'The provider is enrolled with BCBS, proof of enrollment and location is attached for reference.  EFF: 09/05/2017 ', NULL, NULL, '2021-05-05 12:38:12', '2021-05-05 12:38:12'),
(12476, 3046, 20023, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:52:55', '2021-03-12 12:52:55'),
(12477, 1006, 20023, NULL, '2021-05-12 00:00:00.000', 'Approved', 'The provider is enrolled with BCBS, proof of enrollment and location is attached for reference.  EFF: 09/06/2017', NULL, NULL, '2021-05-05 12:37:00', '2021-05-05 12:37:00'),
(12478, 3040, 20024, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:53:45', '2021-03-12 12:53:45'),
(12479, 3040, 20024, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-26 14:52:02', '2021-03-26 14:52:02'),
(12480, 3040, 20024, 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 10:44:19', '2021-04-26 10:44:19'),
(12481, 3040, 20024, 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 09:11:30', '2021-05-31 09:11:30'),
(12482, 3040, 20025, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:01', '2021-03-12 12:54:01'),
(12483, 3040, 20025, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:54:18', '2021-03-26 14:54:18'),
(12484, 3040, 20025, 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 10:45:21', '2021-04-26 10:45:21'),
(12485, 3040, 20025, 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 09:11:32', '2021-05-31 09:11:32'),
(12486, 3040, 20026, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:17', '2021-03-12 12:54:17'),
(12487, 3040, 20026, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:56:30', '2021-03-26 14:56:30'),
(12488, 3040, 20026, 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 10:45:08', '2021-04-26 10:45:08'),
(12489, 3040, 20026, NULL, NULL, 'Revalidated', 'Email rcvd from: David.Balli@molinahealthcare.com  Subject: Provider Affiliation Query - VMUC - Molina  Good Afternoon Brad  I reviewed each of the PCP’s individual NPI numbers.  The majority of the providers are not contracted or affiliated to Valley Med.  Please fill out the contract request form to add or affiliate them to the group and to get them contracted, please review the attached spreadsheet.  I have attached the Contract request form, please fill out the form for each provider and email or fax it in, information located at the top of the form.   Please call me if you have any questions.    Provider Name               NPI#                Contract  Eder Hernandez      1386956852         Affiliated         Yes  Thank you David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc.', NULL, NULL, '2021-04-26 11:15:31', '2021-04-26 11:15:31'),
(12490, 3046, 20027, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:34', '2021-03-12 12:54:34'),
(12491, 3040, 20027, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Christus Health Plan for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:01:29', '2021-06-07 10:01:29'),
(12492, 1006, 20027, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following response from Michal Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Thank you for sending this notice.  Coastal Bend Urgent Care LLC is contracted with CHRISTUS Health as an Ancillary Provider.  We credential the clinics and not the individual practitioners.  The participating provider is COASTAL BEND URGENT CARE.  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – re # FL01383347.  Let me know if you any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818  www.christushealthplan.org Dignity. Integrity. Excellence. Compassion. Stewardship.\"  Sent reply: \"Hello Michal,   I appreciate the update, I just wanted to verify if GWMC had been loaded under the group? Also, could you please let me know what the effective date is for the group?   Thank you!\" ', NULL, NULL, '2021-06-24 14:51:30', '2021-06-24 14:51:30'),
(12493, 1006, 20027, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following approval confirmation email Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Hello Brad,  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – reference # FL01383347.  Thanks, Michal\"', NULL, NULL, '2021-07-13 16:33:05', '2021-07-13 16:33:05'),
(12494, 3046, 20028, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:42', '2021-03-12 12:54:42'),
(12495, 3040, 20028, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Christus Health Plan for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:01:37', '2021-06-07 10:01:37'),
(12496, 1006, 20028, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following response from Michal Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Thank you for sending this notice.  Coastal Bend Urgent Care LLC is contracted with CHRISTUS Health as an Ancillary Provider.  We credential the clinics and not the individual practitioners.  The participating provider is COASTAL BEND URGENT CARE.  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – re # FL01383347.  Let me know if you any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818  www.christushealthplan.org Dignity. Integrity. Excellence. Compassion. Stewardship.\"  Sent reply: \"Hello Michal,   I appreciate the update, I just wanted to verify if GWMC had been loaded under the group? Also, could you please let me know what the effective date is for the group?   Thank you!\" ', NULL, NULL, '2021-06-24 14:51:26', '2021-06-24 14:51:26'),
(12497, 1006, 20028, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following approval confirmation email Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Hello Brad,  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – reference # FL01383347.  Thanks, Michal\"', NULL, NULL, '2021-07-13 16:33:18', '2021-07-13 16:33:18'),
(12498, 3046, 20029, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:57', '2021-03-12 12:54:57');
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
(12499, 3040, 20029, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Christus Health Plan for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:01:40', '2021-06-07 10:01:40'),
(12500, 1006, 20029, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following response from Michal Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Thank you for sending this notice.  Coastal Bend Urgent Care LLC is contracted with CHRISTUS Health as an Ancillary Provider.  We credential the clinics and not the individual practitioners.  The participating provider is COASTAL BEND URGENT CARE.  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – re # FL01383347.  Let me know if you any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 (f) 210-766-8818  www.christushealthplan.org Dignity. Integrity. Excellence. Compassion. Stewardship.\"  Sent reply: \"Hello Michal,   I appreciate the update, I just wanted to verify if GWMC had been loaded under the group? Also, could you please let me know what the effective date is for the group?   Thank you!\" ', NULL, NULL, '2021-06-24 14:51:23', '2021-06-24 14:51:23'),
(12501, 1006, 20029, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Received the following approval confirmation email Simms, Michal michal.simms@christushealth.org:  Sub: Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Amerigroup ||  \"Hello Brad,  George West Medical Clinic has been credentialed effective 11/19/2020 and will be loaded in the next few days under the Coastal Bend Urgent Care records – reference # FL01383347.  Thanks, Michal\"', NULL, NULL, '2021-07-13 16:33:28', '2021-07-13 16:33:28'),
(12502, 3040, 20030, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:54:59', '2021-03-12 12:54:59'),
(12503, 3040, 20030, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-03-26 14:58:26', '2021-03-26 14:58:26'),
(12504, 3040, 20030, 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 10:44:51', '2021-04-26 10:44:51'),
(12505, 3040, 20030, 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 09:11:41', '2021-05-31 09:11:41'),
(12506, 3040, 20031, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:57:46', '2021-03-12 12:57:46'),
(12507, 3040, 20031, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:36:45', '2021-03-24 15:36:45'),
(12508, 3040, 20032, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:02', '2021-03-12 12:58:02'),
(12509, 3040, 20032, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:20', '2021-03-24 15:37:20'),
(12510, 3040, 20033, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:15', '2021-03-12 12:58:15'),
(12511, 3040, 20033, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:46', '2021-03-24 15:37:46'),
(12512, 3040, 20034, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:29', '2021-03-12 12:58:29'),
(12513, 3040, 20034, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:38:13', '2021-03-24 15:38:13'),
(12514, 3040, 20035, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:43', '2021-03-12 12:58:43'),
(12515, 3040, 20035, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:39:59', '2021-03-24 15:39:59'),
(12516, 3046, 20036, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:54', '2021-03-12 12:58:54'),
(12517, 3040, 20036, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject:Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Christus Spohn||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Christus Spohn for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:05:21', '2021-06-07 10:05:21'),
(12518, 1006, 20036, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Found correct email for follow-ups and sent email @ vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hello Vicki,   I hope you\'re doing well, we wanted to enroll the following group and providers with Christus Spohn, their information is below:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please let me know what is required to proceed with this request and also who I should contact for enrollment requests.   Thank you!\"', NULL, NULL, '2021-06-24 15:01:22', '2021-06-24 15:01:22'),
(12519, 1006, 20036, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub; Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  Happy TGIF!  The request for extending a contract has been approved. We charge credentialing fees for mid-levels and physicians. How many will be contracted in those below locations?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with:  \"Hello Vicki,   I appreciate the update, would we be able to do an ancillary contract as we\'re urgent care, or do the individual practitioners need to be enrolled? If so, can you please let me know what the fees are.  Thank you. \"', NULL, NULL, '2021-07-13 16:53:31', '2021-07-13 16:53:31'),
(12520, 1006, 20036, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:58:49', '2021-07-26 08:58:49'),
(12521, 3040, 20037, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:58:59', '2021-03-12 12:58:59'),
(12522, 3040, 20037, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:30', '2021-03-24 15:40:30'),
(12523, 3040, 20038, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:59:11', '2021-03-12 12:59:11'),
(12524, 3040, 20038, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:41:29', '2021-03-24 15:41:29'),
(12525, 3046, 20039, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:59:15', '2021-03-12 12:59:15'),
(12526, 3040, 20039, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:  CSHNproviderrelations@christushealth.org  Subject:Enroll Providers || Coastal Bend Urgent Care & George West Medical Clinic || Providers || Christus Spohn||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Christus Spohn for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 10:05:24', '2021-06-07 10:05:24'),
(12527, 1006, 20039, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Found correct email for follow-ups and sent email @ vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hello Vicki,   I hope you\'re doing well, we wanted to enroll the following group and providers with Christus Spohn, their information is below:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please let me know what is required to proceed with this request and also who I should contact for enrollment requests.   Thank you!\"', NULL, NULL, '2021-06-24 15:01:32', '2021-06-24 15:01:32'),
(12528, 1006, 20039, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub; Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  Happy TGIF!  The request for extending a contract has been approved. We charge credentialing fees for mid-levels and physicians. How many will be contracted in those below locations?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with:  \"Hello Vicki,   I appreciate the update, would we be able to do an ancillary contract as we\'re urgent care, or do the individual practitioners need to be enrolled? If so, can you please let me know what the fees are.  Thank you. \"', NULL, NULL, '2021-07-13 16:53:57', '2021-07-13 16:53:57'),
(12529, 1006, 20039, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  Good question! The Urgent Cares are contracted as individual practitioners. This does not mean all your providers need to be contracted if you feel on physicians would see members versus mid-levels. Or, if your Urgent Care group will use a modifier where mid-levels do see our members but the claim will bill under the physician.  Does this answer your question(s)? If not please let me know.\"  Replied with:  \"Hello Vicki,   I appreciate the update, our physician will not be seeing the patients it will only be the Mid-levels and we bill using the group\'s information except for the rendering NPI which will use the NPI of the provider that saw the patient. How would you suggest that we proceed?  Thank you. \"', NULL, NULL, '2021-08-03 17:06:39', '2021-08-03 17:06:39'),
(12530, 1006, 20039, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Received the following update from vicki.guerra@christushealth.org:  Sub; Enrollment Request - CBUC/GWMC - Christus Spohn  \"Thanks Brad! Who will follow the patients if admitted into the hospital? Does this group contract with one of our hospitalists groups at a Christus Facility or another physician who has priveleges?  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with:  \"Hello Vicki,   The supervising physician for the group does have hospital privileges, their information is as follows:  Frank Dehnisch  NPI# 1952376345  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-08-05 12:52:59', '2021-08-05 12:52:59'),
(12531, 1006, 20039, NULL, '2021-08-23 00:00:00.000', 'In Process', 'We received the following request from vicki.guerra@christushealth.org:  Sub: Enrollment Request - CBUC/GWMC - Christus Spohn  \"Hi Brad,  What is the last 4 ss?  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Replied with providers last 4 SSN. ', NULL, NULL, '2021-08-16 17:05:08', '2021-08-16 17:05:08'),
(12532, 11056, 20039, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : vicki.guerra@christushealth.org  Sub : Re: Enrollment Request - CBUC/GWMC - Christus Spohn  Hi Brad,     Happy Wednesday!     I do not find the provider did his reappointment paperwork with the Christus hospital facility.     Can the provider be asked if he re-did hospital facility paperwork?     Thanks,        Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2021-08-25 08:16:54', '2021-08-25 08:16:54'),
(12533, 11056, 20039, NULL, '2021-09-27 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-20 16:39:01', '2021-09-20 16:39:01'),
(12534, 11056, 20039, NULL, '2021-10-07 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-09-30 13:50:14', '2021-09-30 13:50:14'),
(12535, 11056, 20039, NULL, '2021-10-14 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-07 17:02:10', '2021-10-07 17:02:10'),
(12536, 11056, 20039, NULL, '2021-10-25 00:00:00.000', 'In Process', 'We have informed the provider. Still waiting for his response.', NULL, NULL, '2021-10-18 16:38:11', '2021-10-18 16:38:11'),
(12537, 11056, 20039, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Have emailed them again. Waiting for response.', NULL, NULL, '2021-11-10 09:23:17', '2021-11-10 09:23:17'),
(12538, 11056, 20039, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Have emailed them again. Waiting for response.  It has been along that we get n response from the provider.', NULL, NULL, '2021-11-15 16:59:21', '2021-11-15 16:59:21'),
(12539, 3040, 20040, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 12:59:25', '2021-03-12 12:59:25'),
(12540, 3040, 20040, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:59', '2021-03-24 15:40:59'),
(12541, 3040, 20041, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:00:52', '2021-03-12 13:00:52'),
(12542, 3040, 20041, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. ', NULL, NULL, '2021-03-24 15:02:37', '2021-03-24 15:02:37'),
(12543, 3040, 20042, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:01:11', '2021-03-12 13:01:11'),
(12544, 3040, 20042, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-03-24 15:03:22', '2021-03-24 15:03:22'),
(12545, 3040, 20043, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:01:24', '2021-03-12 13:01:24'),
(12546, 3040, 20043, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers. ', NULL, NULL, '2021-03-24 15:35:37', '2021-03-24 15:35:37'),
(12547, 3040, 20044, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:01:36', '2021-03-12 13:01:36'),
(12548, 3040, 20044, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:36:13', '2021-03-24 15:36:13'),
(12549, 3040, 20045, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:01:52', '2021-03-12 13:01:52'),
(12550, 3040, 20045, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:36:52', '2021-03-24 15:36:52'),
(12551, 3040, 20046, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:02:14', '2021-03-12 13:02:14'),
(12552, 3040, 20046, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:24', '2021-03-24 15:37:24'),
(12553, 3040, 20047, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:02:29', '2021-03-12 13:02:29'),
(12554, 3040, 20047, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:50', '2021-03-24 15:37:50'),
(12555, 3040, 20048, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:02:43', '2021-03-12 13:02:43'),
(12556, 3040, 20048, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:38:17', '2021-03-24 15:38:17'),
(12557, 3040, 20049, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:02:58', '2021-03-12 13:02:58'),
(12558, 3040, 20049, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:04', '2021-03-24 15:40:04'),
(12559, 3040, 20050, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:03:16', '2021-03-12 13:03:16'),
(12560, 3040, 20050, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:35', '2021-03-24 15:40:35'),
(12561, 3046, 20051, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:03:26', '2021-03-12 13:03:26'),
(12562, 1006, 20051, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Sent f/u email @ Intake_PDM@cigna.com:  Sub: Enrollment Status - Katherine Paterson - CBUC  \"Hello,  I hope you\'re doing well, I wanted to get an update on the enrollment status for the following providers and group: Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Provider Name: Katherine Paterson  NPI# 1164776548  Provider Name: Jennifer Tudor  NPI# 1720455835  Provider Name: Mercedita Flynn NPI# 1619166188  Please get back to me as soon as possible as this request has been pending for the past few months.   Thank you. \"', NULL, NULL, '2021-05-05 13:24:05', '2021-05-05 13:24:05'),
(12563, 1006, 20051, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent a f/u email @ PDM COGZ PDMCOGZ@cigna.com & intake_pdm@cigna.com:  Sub: Enrollment Query - CBUC/GWMC - Cigna  \"Hello,   I wanted to verify if the following group and providers were enrolled with Cigna under the mentioned addresses:   Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-06-09 10:10:36', '2021-06-09 10:10:36'),
(12564, 1006, 20051, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Coastal Bend Urgent Care:  Eff: 07/06/2017 Provider ID# 9355952  Ref# Ivan C 06/29/2021  Location confirmation attached. ', NULL, NULL, '2021-06-29 12:12:53', '2021-06-29 12:12:53'),
(12565, 3040, 20052, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:03:30', '2021-03-12 13:03:30'),
(12566, 3040, 20052, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:41:34', '2021-03-24 15:41:34'),
(12567, 3040, 20053, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:03:44', '2021-03-12 13:03:44'),
(12568, 3040, 20053, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:41:05', '2021-03-24 15:41:05'),
(12569, 3040, 20054, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:04:06', '2021-03-12 13:04:06'),
(12570, 3040, 20054, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. ', NULL, NULL, '2021-03-24 15:02:45', '2021-03-24 15:02:45'),
(12571, 3040, 20055, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:04:25', '2021-03-12 13:04:25'),
(12572, 3040, 20055, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-03-24 15:03:27', '2021-03-24 15:03:27'),
(12573, 3040, 20056, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:04:44', '2021-03-12 13:04:44'),
(12574, 3040, 20056, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers. ', NULL, NULL, '2021-03-24 15:35:42', '2021-03-24 15:35:42'),
(12575, 3040, 20057, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:04:57', '2021-03-12 13:04:57'),
(12576, 3040, 20057, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:36:18', '2021-03-24 15:36:18'),
(12577, 3040, 20058, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:05:13', '2021-03-12 13:05:13'),
(12578, 3040, 20058, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:36:56', '2021-03-24 15:36:56'),
(12579, 3040, 20059, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:05:27', '2021-03-12 13:05:27'),
(12580, 3040, 20059, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:28', '2021-03-24 15:37:28'),
(12581, 3040, 20060, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:05:40', '2021-03-12 13:05:40'),
(12582, 3040, 20060, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:37:54', '2021-03-24 15:37:54'),
(12583, 3040, 20061, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:05:53', '2021-03-12 13:05:53'),
(12584, 3040, 20061, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:38:22', '2021-03-24 15:38:22'),
(12585, 3046, 20062, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:05:58', '2021-03-12 13:05:58'),
(12586, 1006, 20062, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Sent f/u email @ Intake_PDM@cigna.com:  Sub: Enrollment Status - Katherine Paterson - CBUC  \"Hello,  I hope you\'re doing well, I wanted to get an update on the enrollment status for the following providers and group: Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Provider Name: Katherine Paterson  NPI# 1164776548  Provider Name: Jennifer Tudor  NPI# 1720455835  Provider Name: Mercedita Flynn NPI# 1619166188  Please get back to me as soon as possible as this request has been pending for the past few months.   Thank you. \"', NULL, NULL, '2021-05-05 13:23:55', '2021-05-05 13:23:55'),
(12587, 1006, 20062, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent a f/u email @ PDM COGZ PDMCOGZ@cigna.com & intake_pdm@cigna.com:  Sub: Enrollment Query - CBUC/GWMC - Cigna  \"Hello,   I wanted to verify if the following group and providers were enrolled with Cigna under the mentioned addresses:   Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-06-09 10:10:52', '2021-06-09 10:10:52'),
(12588, 1006, 20062, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Mercedita Flynn: Eff: 12/01/2016 Provider ID# 7168847  Ref# Ivan C 06/29/2021  Location confirmation is attached for reference. ', NULL, NULL, '2021-06-29 12:11:57', '2021-06-29 12:11:57'),
(12589, 3040, 20063, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:06:05', '2021-03-12 13:06:05'),
(12590, 3040, 20063, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:09', '2021-03-24 15:40:09'),
(12591, 3040, 20064, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:06:17', '2021-03-12 13:06:17'),
(12592, 3040, 20064, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:40:40', '2021-03-24 15:40:40'),
(12593, 3046, 20065, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:06:22', '2021-03-12 13:06:22'),
(12594, 1006, 20065, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Sent f/u email @ Intake_PDM@cigna.com:  Sub: Enrollment Status - Katherine Paterson - CBUC  \"Hello,  I hope you\'re doing well, I wanted to get an update on the enrollment status for the following providers and group: Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Provider Name: Katherine Paterson  NPI# 1164776548  Provider Name: Jennifer Tudor  NPI# 1720455835  Provider Name: Mercedita Flynn NPI# 1619166188  Please get back to me as soon as possible as this request has been pending for the past few months.   Thank you. \"', NULL, NULL, '2021-05-05 13:23:51', '2021-05-05 13:23:51'),
(12595, 1006, 20065, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent a f/u email @ PDM COGZ PDMCOGZ@cigna.com & intake_pdm@cigna.com:  Sub: Enrollment Query - CBUC/GWMC - Cigna  \"Hello,   I wanted to verify if the following group and providers were enrolled with Cigna under the mentioned addresses:   Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-06-09 10:10:57', '2021-06-09 10:10:57'),
(12596, 1006, 20065, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Jennifer Tudor: Eff: 12/01/2016 Provider ID# 4740849  Ref# Ivan C 06/29/2021  Location confirmation is attached for reference. ', NULL, NULL, '2021-06-29 12:11:12', '2021-06-29 12:11:12'),
(12597, 3040, 20066, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:06:32', '2021-03-12 13:06:32'),
(12598, 3040, 20066, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:41:39', '2021-03-24 15:41:39'),
(12599, 3040, 20067, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:06:49', '2021-03-12 13:06:49'),
(12600, 3040, 20067, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the providers.  ', NULL, NULL, '2021-03-24 15:41:10', '2021-03-24 15:41:10'),
(12601, 3040, 20068, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:08:57', '2021-03-12 13:08:57'),
(12602, 3040, 20068, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:51:22', '2021-03-25 09:51:22'),
(12603, 3040, 20069, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:09:18', '2021-03-12 13:09:18'),
(12604, 3040, 20069, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:53:46', '2021-03-25 09:53:46'),
(12605, 3040, 20070, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:09:40', '2021-03-12 13:09:40'),
(12606, 3040, 20070, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:55:28', '2021-03-25 09:55:28'),
(12607, 3040, 20071, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:09:59', '2021-03-12 13:09:59'),
(12608, 3040, 20071, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:56:59', '2021-03-25 09:56:59'),
(12609, 3040, 20072, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:11:05', '2021-03-12 13:11:05'),
(12610, 3040, 20072, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachment. ', NULL, NULL, '2021-03-25 09:38:31', '2021-03-25 09:38:31'),
(12611, 3040, 20073, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:11:21', '2021-03-12 13:11:21'),
(12612, 3040, 20073, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-03-25 09:40:03', '2021-03-25 09:40:03'),
(12613, 3040, 20074, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:11:39', '2021-03-12 13:11:39'),
(12614, 3040, 20074, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:45:33', '2021-03-25 09:45:33'),
(12615, 3040, 20075, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:12:05', '2021-03-12 13:12:05'),
(12616, 3040, 20075, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:51:17', '2021-03-25 09:51:17'),
(12617, 3040, 20076, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:12:25', '2021-03-12 13:12:25'),
(12618, 3040, 20076, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:53:41', '2021-03-25 09:53:41'),
(12619, 3040, 20077, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:12:49', '2021-03-12 13:12:49'),
(12620, 3040, 20077, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:55:24', '2021-03-25 09:55:24'),
(12621, 3040, 20078, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:06', '2021-03-12 13:13:06'),
(12622, 3040, 20078, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:56:54', '2021-03-25 09:56:54'),
(12623, 3046, 20079, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:38', '2021-03-12 13:13:38'),
(12624, 1005, 20079, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:30:39', '2021-06-07 17:30:39'),
(12625, 1006, 20079, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:51:10', '2021-07-23 12:51:10'),
(12626, 11056, 20079, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:29:02', '2021-08-18 13:29:02'),
(12627, 11056, 20079, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope you are doing well. Please provide me with the latest updates soon. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:14:22', '2021-08-24 11:14:22'),
(12628, 11056, 20079, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates soon. I am still waiting to get enrollment status and about the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Eagerly, waiting to hear back from you soon.  Thank you! Have a great week ahead!   Call didn\'t received. Left out the voice mail regarding the enrollment status', NULL, NULL, '2021-09-02 11:19:55', '2021-09-02 11:19:55'),
(12629, 11056, 20079, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', '	 Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:08:09', '2021-09-24 13:08:09'),
(12630, 3046, 20080, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:42', '2021-03-12 13:13:42'),
(12631, 1005, 20080, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:30:34', '2021-06-07 17:30:34'),
(12632, 1006, 20080, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:51:44', '2021-07-23 12:51:44'),
(12633, 11056, 20080, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:28:54', '2021-08-18 13:28:54'),
(12634, 11056, 20080, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope you are doing well. Please provide me with the latest updates soon. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:14:16', '2021-08-24 11:14:16'),
(12635, 11056, 20080, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates soon. I am still waiting to get enrollment status and about the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Eagerly, waiting to hear back from you soon.  Thank you! Have a great week ahead!   Call didn\'t received. Left out the voice mail regarding the enrollment status', NULL, NULL, '2021-09-02 11:19:50', '2021-09-02 11:19:50'),
(12636, 11056, 20080, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', '	 Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:08:03', '2021-09-24 13:08:03'),
(12637, 3046, 20081, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:46', '2021-03-12 13:13:46'),
(12638, 1005, 20081, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:30:31', '2021-06-07 17:30:31'),
(12639, 1006, 20081, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:51:40', '2021-07-23 12:51:40'),
(12640, 11056, 20081, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub :  Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:28:45', '2021-08-18 13:28:45'),
(12641, 11056, 20081, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope you are doing well. Please provide me with the latest updates soon. I want to inquire about the enrollment status and the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 11:14:10', '2021-08-24 11:14:10'),
(12642, 11056, 20081, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com &  TXMAContracting@cigna.com  &  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  Good morning!  Hope this email finds you well. Please provide me with the latest updates soon. I am still waiting to get enrollment status and about the Network interest forms which have been submitted on 23rd of July,2021 of the below mentioned practice and providers :  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know. Eagerly, waiting to hear back from you soon.  Thank you! Have a great week ahead!   Call didn\'t received. Left out the voice mail regarding the enrollment status', NULL, NULL, '2021-09-02 11:19:40', '2021-09-02 11:19:40'),
(12643, 11056, 20081, NULL, '2021-10-01 00:00:00.000', 'Not Eligible', '	 Email received from : lerensa.crain@careallies.com  Sub : Enrollment Status Updates - CBUC/GWMC - Cigna Healthspring  George West, Texas and Beeville, Texas are not in the Cigna MA medical plan service area.', NULL, NULL, '2021-09-24 13:07:57', '2021-09-24 13:07:57'),
(12644, 3046, 20082, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:48', '2021-03-12 13:13:48'),
(12645, 1005, 20082, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Cigna\'s approval.', NULL, NULL, '2021-06-07 17:30:26', '2021-06-07 17:30:26'),
(12646, 1006, 20082, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent enrollment request @ TXMAContracting@cigna.com:  Sub: Network Interest Form - CBUC/GWMC - Cigna Healthspring  \"Hello,   Please find the attached network interest form, do let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-23 12:51:36', '2021-07-23 12:51:36'),
(12647, 1006, 20082, NULL, '2021-08-02 00:00:00.000', 'Not Eligible', 'The provider is no longer a part of the group as per Ryan. ', NULL, NULL, '2021-07-26 08:59:02', '2021-07-26 08:59:02'),
(12648, 3040, 20083, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:13:50', '2021-03-12 13:13:50'),
(12649, 3040, 20083, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachment. ', NULL, NULL, '2021-03-25 09:38:36', '2021-03-25 09:38:36'),
(12650, 3040, 20084, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:14:09', '2021-03-12 13:14:09'),
(12651, 3040, 20084, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-03-25 09:40:07', '2021-03-25 09:40:07'),
(12652, 3040, 20085, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:14:26', '2021-03-12 13:14:26'),
(12653, 3040, 20085, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No Need to add individual provider. ', NULL, NULL, '2021-03-25 09:45:38', '2021-03-25 09:45:38'),
(12654, 3040, 20086, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:14:37', '2021-03-12 13:14:37'),
(12655, 3040, 20086, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 09:47:59', '2021-03-25 09:47:59'),
(12656, 3046, 20087, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 13:15:41', '2021-03-12 13:15:41'),
(12657, 1006, 20087, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Sent enrollment email request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Provider Enrollment - Galaxy Health - CBUC  \"Hello,   We wish to enroll/contract our group and providers with Galaxy Health, their information is as follows: Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264  Provider Name: Katherine Paterson NPI# 1164776548 Provider Name: Jennifer Tudor NPI# 1720455835 Provider Name: Mercedita Flynn NPI# 1619166188  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-05 14:51:25', '2021-05-05 14:51:25');
