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
(46429, 20067, 31378, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub: Re: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare   Good Evening!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-listed providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Nubia Benavides	1801371935	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Nubia Benavides	1801371935	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Nubia Benavides	1801371935	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Edna Michi	1992293906	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Edna Michi	1992293906	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Edna Michi	1992293906	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Juan Hernandez	1225617558	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Juan Hernandez	1225617558	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Juan Hernandez	1225617558	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Jeniece Wert	1659919702	800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Jeniece Wert	1659919702	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Thank you,', NULL, NULL, '2022-03-02 17:06:03', '2022-03-02 17:06:03'),
(46430, 20067, 31378, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: jtrenz@humana.com   Sub: RE: Enrollment Status Query - Valley Med Urgent Care PLLC - Tricare  Good afternoon –     1)  Nubia Benavides  -   There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please use the attached form to submit a name update/correction.  Be sure to check the box at the top which states “Update Solo Practitioner Name”.  This needs to be corrected before credentialing can be completed. Please fax completed form to 608-221-7535.     2) Edna Michi – Please complete the 2nd attachment (Provider Roster).  On the first spreadsheet tab, include all information of the three locations.  On the second tab for Professional Info, please complete with all information on the professional provider. This will add the provider to the 3 locations.  Once complete, please email this form to HGBProviderRosters@humana.com.     3)  Juan Hernandez – There is a discrepancy with this providers’ name in the TRICARE system.  In our system, the name is showing as    Please follow the same instructions for the form as with #1, Nubia Benavides.     4)  Jeniece Wert – Provider profile is complete.   101 E Expressway 83, Ste 170, McAllen Texas – Effective date 1/31/2022  800 E Alton Gloor, Brownsville TX – Effective date 1/31/2022.     Thank you,  Jacque Trenz', NULL, NULL, '2022-03-10 15:15:44', '2022-03-10 15:15:44'),
(46431, 20067, 31378, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Fax the provider update info at 608-221-7535  See the attachment', NULL, NULL, '2022-03-10 15:28:12', '2022-03-10 15:28:12'),
(46432, 1006, 31379, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46433, 1005, 31379, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s Enrollment.', NULL, NULL, '2021-06-04 09:35:22', '2021-06-04 09:35:22'),
(46434, 3040, 31379, NULL, '2021-06-21 00:00:00.000', 'In Process', 'I had a word with (Liya) Wellcare representative and she sent the request to provider rep. department and they will contact us regarding the enrollment.   Ref: 507756828 ', NULL, NULL, '2021-06-14 15:59:24', '2021-06-14 15:59:24'),
(46435, 3040, 31379, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'We sent the ancillary contract request for group. For more details please see group task. ', NULL, NULL, '2021-06-18 16:20:41', '2021-06-18 16:20:41'),
(46436, 3040, 31379, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject; Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in our group Valley Med Urgent Care PLLC under the below locations. As we submitted an online form.   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      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 11:18:00', '2021-07-20 11:18:00'),
(46437, 3040, 31379, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,    Hope you are doing well. Please advise the enrollment status for the remaining providers in Wellcare in 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: Lira, Arturo Alejandro  Provider NPI# 1245789502     Provider 3:  Provider Name: Lopez, Mayra Alejandra  Provider NPI# 1265945125    Provider 4:  Provider Name: Hernandez, Juan  Provider NPI# 1225617558    If you need any additional information please let me know. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-09-07 13:57:09', '2021-09-07 13:57:09'),
(46438, 10057, 31379, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status for the remaining providers in Wellcare in 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 Lira, Arturo Alejandro	1245789502 Lopez, Mayra Alejandra	1265945125 Hernandez, Juan	1225617558  Please get back to me as soon as you get a chance. Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 13:24:24', '2021-10-19 13:24:24'),
(46439, 10057, 31379, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Re: Become A Provider - Unsecured - General Practice - Texas  Dear Provider:  Thank you for your interest in joining the Wellcare network.  Please allow us 30 calendar days to review your request.  A Centene contracting representative will reach out to you within 30 calendar days.  Please note:  In response to your request to join the Wellcare network, you may receive correspondence from a Superior Health Plan email address.   Thank you once again for your interest.  Sincerely, Network Management', NULL, NULL, '2021-11-17 10:11:05', '2021-11-17 10:11:05'),
(46440, 10057, 31379, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon,  I have submitted the remaining below mentioned provider forms via your website, let me know the update.  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 Edna Michi	1992293906 Nubia Benavides	1801371935 Garcia, Homero	1730564857 Juan Hernandez	1225617558 Lopez, Mayra	1265945125  Please find the attached forms for your reference as well.  Thanks & Regards,', NULL, NULL, '2021-11-30 16:10:12', '2021-11-30 16:10:12'),
(46441, 10057, 31379, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned providers request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-07 15:38:33', '2021-12-07 15:38:33'),
(46442, 10057, 31379, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Hello,  The providers below are PAR.  Sincerely, Network Management– Texas', NULL, NULL, '2021-12-17 15:29:55', '2021-12-17 15:29:55'),
(46443, 10057, 31379, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Thank you for reaching out. Can I get the welcome packets of mentioned providers?  Looking forward to hearing from you soon.  Regards,', NULL, NULL, '2021-12-27 12:56:58', '2021-12-27 12:56:58'),
(46444, 10057, 31379, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Morning,  Here is a list of par providers for your contract, and the welcome letter.  Please see attachment.  Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-30 14:26:07', '2021-12-30 14:26:07'),
(46445, 20067, 31379, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Group || WellCare ||   Good afternoon,  Hope you are doing well. I want to know the enrollment status of the below-mentioned providers. 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 Juan Hernandez	1225617558 Homero garcia	1730564857 Mayra Lopez	1265945125  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-05 17:53:04', '2022-01-05 17:53:04'),
(46446, 20067, 31379, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||  Good Afternoon!  Hope you had a great weekend. Any updates on the below-mentioned request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 14:22:45', '2022-01-18 14:22:45'),
(46447, 20067, 31379, NULL, '2022-02-07 00:00:00.000', 'In Process', 'Received the effective date but not confirm for which location, Will approve the task next week after the confirmation.', NULL, NULL, '2022-01-31 09:49:24', '2022-01-31 09:49:24'),
(46448, 20067, 31379, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: Re: Enrollment Status || Valley Med Urgent Care PLLC || Group || Wellcare ||   Good Morning,   Welcome letters will only have one address on them. The provider was requested to be loaded to 3 addresses and they are par for them all:', NULL, NULL, '2022-02-08 12:45:38', '2022-02-08 12:45:38'),
(46449, 1006, 31380, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46450, 1005, 31380, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:26:57', '2021-06-04 09:26:57'),
(46451, 3040, 31380, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Provider enrolled in Medicare. I tried to enroll the provider in Medicare Railroad but  PTAN is not uploaded in Medicare Railroad system. It will take sometime to show up in their system. ', NULL, NULL, '2021-06-14 08:42:23', '2021-06-14 08:42:23'),
(46452, 11056, 31380, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001260', NULL, NULL, '2021-06-29 14:55:03', '2021-06-29 14:55:03'),
(46453, 3040, 31380, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN A HERNANDEZ PA PROVIDER PTAN	Q00092312 PROVIDER NPI	1225617558 EFFECTIVE DATE	05/01/2021', NULL, NULL, '2021-07-20 07:03:38', '2021-07-20 07:03:38'),
(46454, 1006, 31381, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46455, 3040, 31381, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Applicant Name: JUAN HERNANDEZ  Tracking ID: T060420210002625  Submitted Date: FRI - JUNE 04 2021 02:48:47 PM EST  Submitted By: Juan Hernandez  Contact Email(s): VMUC@CLAIMSMEDINC.COM JUANAHDZ21@GMAIL.COM', NULL, NULL, '2021-06-04 13:50:37', '2021-06-04 13:50:37'),
(46456, 3040, 31381, NULL, '2021-06-18 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: JUAN HERNANDEZ Individual Specialty: PHYSICIAN ASSISTANT Individual National Provider Identifier (NPI): 1225617558 Individual Provider Transaction Access Number (PTAN): 1Q2215 Individual PTAN Effective Date: MAY 1, 2021 Employer Legal Business Name (LBN): VALLEY MED URGENT CARE PLLC Employer National Provider Identifier (NPI): 1518404631 Employer Provider Transaction Access Number (PTAN): 578343', NULL, NULL, '2021-06-11 16:24:37', '2021-06-11 16:24:37'),
(46457, 1006, 31382, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46458, 3040, 31382, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.  ', NULL, NULL, '2021-06-04 13:20:40', '2021-06-04 13:20:40'),
(46459, 1006, 31383, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46460, 3040, 31383, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task.  ', NULL, NULL, '2021-06-04 14:22:01', '2021-06-04 14:22:01'),
(46461, 1006, 31384, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46462, 1005, 31384, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:36:49', '2021-06-04 09:36:49'),
(46463, 3040, 31384, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: AM.Hidalgo@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Healthplan in 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: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:49:18', '2021-07-12 10:49:18'),
(46464, 10057, 31384, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : AM.Hidalgo@superiorhealthplan.com  Sub : Status Request - Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Morning,  Hope this email finds you well. I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  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 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  If you have any questions please let us know, we will be happy to help.  Thanks & Regards,', NULL, NULL, '2021-10-05 10:52:00', '2021-10-05 10:52:00'),
(46465, 10057, 31384, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : SHP.NetworkDevelopment@superiorhealthplan.com, AM.Houston@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon,  Hope this email finds you well. I want to get the latest update on my credentialing application for below mentioned providers under the facility tax I.D.  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 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702  Looking forward to hearing from you soon. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 15:22:36', '2021-11-08 15:22:36'),
(46466, 10057, 31384, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com,   Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Hello Region 4,  Provider is requesting assistance with contract status. Location is in Brownsville, Tx  Can someone please assist?  Thank you, Patricia Torres', NULL, NULL, '2021-11-09 11:45:53', '2021-11-09 11:45:53'),
(46467, 10057, 31384, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Good Evening,  Please view the following provider Credentialing status:  Hernandez, Juan NPI: 1225617558 TIN: 815123542 is under Credentialing, please allow additional time to process.  Wert, Jeniece K NPI: 1659919702 TIN: 815123542 Effective Date: 12/1/2021  Respectfully,  Daniel Velez Provider Account Manager,', NULL, NULL, '2021-11-30 10:39:45', '2021-11-30 10:39:45'),
(46468, 10057, 31384, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Daniel,  Hope you are doing well. I really appreciate your response to this request. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-06 15:52:30', '2021-12-06 15:52:30'),
(46469, 10057, 31384, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Greetings!  Any update on the Juan Hernandez, NPI - 1225617558, TIN: 815123542 request.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-14 17:22:03', '2021-12-14 17:22:03'),
(46470, 10057, 31384, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Morning,  I\'m writing this email to check the status for the below mentioned request. This is my SECOND REMINDER. Kindly update me ASAP!  Regards, Steve Albert ', NULL, NULL, '2021-12-21 09:41:18', '2021-12-21 09:41:18'),
(46471, 10057, 31384, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Received From : Daniel.Velez@superiorhealthplan.com  Sub : Enroll Provider || Valley Med Urgent Care PLLC || Jeniece Wert & Juan Hernandez || Ambetter ||  Good Afternoon Steve,  Juan Hernandez, NPI: 1225617558, TIN: 815123542 is within Credentialing status.  Please allow time to process and feel free to inquire about status updates.', NULL, NULL, '2021-12-28 11:38:28', '2021-12-28 11:38:28'),
(46472, 20067, 31384, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  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    Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-05 10:30:13', '2022-01-05 10:30:13'),
(46473, 20067, 31384, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email Received from  Daniel.Velez@superiorhealthplan.com  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Afternoon Syed,     JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is within Credentialing.     Please allow more time to process and feel free to request status updates.      Respectfully, Daniel Velez.', NULL, NULL, '2022-01-05 14:04:08', '2022-01-05 14:04:08'),
(46474, 20067, 31384, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-18 10:48:14', '2022-01-18 10:48:14'),
(46475, 20067, 31384, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Daniel.Velez@superiorhealthplan.com  Sub: Re: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Hello Syed,  JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 is currently within Credentialing.  At this time, there is no request for missing information. If there is any missing or incomplete information, the cred specialist will contact you immediately.  ', NULL, NULL, '2022-01-28 17:27:17', '2022-01-28 17:27:17'),
(46476, 20067, 31384, NULL, '2022-02-11 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Daniel, Hope all is well with you. Any update on the previous request?  Thanks & Regards, Syed Ahad', NULL, NULL, '2022-02-04 10:30:53', '2022-02-04 10:30:53'),
(46477, 20067, 31384, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Syed,     Provider JUAN ALONSO HERNANDEZ NPI 1225617558 TIN 815123542 completed credentialing and is in-network with Superior HealthPlan effective 3/1/2022.', NULL, NULL, '2022-02-16 15:31:54', '2022-02-16 15:31:54'),
(46478, 20067, 31384, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel!  Thanks for the update. Can you please provide me the welcome letter.  Thank you,', NULL, NULL, '2022-02-16 15:32:46', '2022-02-16 15:32:46'),
(46479, 20067, 31384, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||   Good Morning Syed,     The agreement is sent to leadership for signature, once that has been received back from final signature the Welcome Letter along with the provider contract will be sent.     Please allow extra time for completion and delivery of information.  ', NULL, NULL, '2022-03-02 15:07:50', '2022-03-02 15:07:50'),
(46480, 20067, 31384, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enrollment Query || Valley Med Urgent Care PLLC || Nubia Benavides & Edna Michi || Ambetter   Hello Syed,     There are open records for the following providers below under TIN 815123542, Superior HealthPlan has sent emails to the responsible party and is now awaiting for the applications.     Nubia Olivama Benavides NPI: 1801371935 Email sent on Mon 2/21/2022 2:11 PM Edna Michi NPI: 1992293906 Email sent on Mon 2/21/2022 2:22 PM ', NULL, NULL, '2022-03-17 17:25:24', '2022-03-17 17:25:24'),
(46481, 20067, 31384, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Hello Daniel,  Hope you are well. I haven\'t heard from you, Kindly update me about Juan Hernandez and also confirm that all 3 locations of Valley Med Urgent Care have been added to the provider\'s profile  Thank you,', NULL, NULL, '2022-03-17 17:34:16', '2022-03-17 17:34:16'),
(46482, 20067, 31384, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: Daniel.Velez@superiorhealthplan.com  Sub: Enroll Provider || Valley Med Urgent Care PLLC || Juan Hernandez || Ambetter ||  Good Morning Syed,     Juan Hernandez displays loaded with all 3 locations.     I requested that a copy of the welcome letter be sent to you.  ', NULL, NULL, '2022-03-18 10:03:30', '2022-03-18 10:03:30'),
(46483, 20067, 31384, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Sub:JUAN ALONSO HERNANDEZ WELCOME LETTER  JUAN ALONSO HERNANDEZ  VALLEY MED URGENT CARE PLLC  VMUC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    03/01/2022                                                 C/ 56674 ', NULL, NULL, '2022-03-22 14:53:17', '2022-03-22 14:53:17'),
(46484, 1006, 31385, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46485, 1005, 31385, NULL, '2021-06-12 00:00:00.000', 'Initiated', 'Email sent to: mflores@trpnppo.com ', NULL, NULL, '2021-06-04 15:04:58', '2021-06-04 15:04:58'),
(46486, 11056, 31385, NULL, '2021-06-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub :  Provider Update Information Form- TRPN  Greetings,  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider Names enlisted below:-  Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-18 16:56:52', '2021-06-18 16:56:52'),
(46487, 3040, 31385, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject; Re: Provider Update Information Form- TRPN  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Valley Med Urgent Care PLLC under the below locations. We already submitted the provider update form.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248    Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Provider 2: Provider Name:  Wert, Jeniece Provider NPI : 1659919702   Provider 3: Provider Name:  Lira, Arturo Provider NPI : 1245789502  Provider 4:  Provider Name: Potter, Deborah Provider NPI : 1861914053   Provider 5:   Provider Name:  Wright, Larry Provider NPI :   1033769765  Provider 6:   Provider Name: Naranjo, Diego Provider NPI :  1568929800  Provider 7:   Provider Name: Lopez, Mayra Provider NPI :  1265945125    Provider 8: Provider Name: Rodriguez, Cynthia Provider NPI :  1124282553  Provider 9:   Provider Name:  Garcia, Homero Provider NPI :  1730564857  Provider 10: Provider Name:  Escobar, Angiollet Provider NPI : 1962917997  Provider 11:   Provider Name: Hernandez, Eder Provider NPI :  1386956852  Provider 12:   Provider Name:  Saavedra, Teresa Provider NPI :  1255676151  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 14:47:43', '2021-07-05 14:47:43'),
(46488, 3040, 31385, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, ccampos@trpnppo.com, mflores@trpnppo.com  Subject: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in TRPN for our group under the below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC (Brownsville) Practice NPI: 1518404631 Practice TIN: 81-5123542 Primary Address: 2534 Boca Chica Blvd, Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170, McAllen , TX 78501-1166 Tertiary Address: 800 E Alton Gloor Blvd, Brownsville , TX 78526-4248   Provider 1: Provider Name: Hernandez, Juan Provider NPI : 1225617558  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:40:17', '2021-07-22 16:40:17'),
(46489, 12062, 31385, NULL, '2021-09-29 00:00:00.000', 'In Process', 'SENT A FOLLOW UP MAIL  subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  to:mflores@trpnppo.com trpndataentry@trpnppo.com ccampos@trpnppo.com  Dear Max Flores,  Please update for below.  If there is any further information you need , please feel free to ask me. ', NULL, NULL, '2021-09-21 16:25:06', '2021-09-21 16:25:06'),
(46490, 12062, 31385, NULL, '2021-10-01 00:00:00.000', 'In Process', 'As per the attached mail received from TRPN, the request is completed .However I replied back for a welcome letter and Effective date. To:ccampos@trpnppo.com Subject:RE: Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||   Dear Campos,  Good Day!  Please provide references such as effective date, plans and onboarding letter for a provider with below details in TRPN network. ', NULL, NULL, '2021-09-23 16:42:22', '2021-09-23 16:42:22'),
(46491, 10057, 31385, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Sent To : mflores@trpnppo.com, trpndataentry@trpnppo.com, ccampos@trpnppo.com  Sub : Enrollment Status || Valley Med Urgent Care PLLC || Hernandez, Juan || TRPN ||  Hello,  Hope you are doing well. I\'m writing this email to check the status and to get the effective date along with the welcome letters as well for the below mentioned provider under these 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 Hernandez, Juan	1225617558  Your earliest response will be highly appreciated. have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 15:19:41', '2021-11-02 15:19:41'),
(46492, 10057, 31385, NULL, '2021-11-23 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com, ccampos@trpnppo.com & efry@trpnppo.com  Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Good Morning,  Hope this email finds you well. Please help me out to get the latest enrollment status for below mentioned providers under TIN including all given 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 Edna Michi	1992293906 Nubia Benavides	1801371935 Juan Hernandez	1225617558  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-16 09:42:10', '2021-11-16 09:42:10'),
(46493, 10057, 31385, NULL, '2021-11-24 00:00:00.000', 'Approved', '	 Email Received From : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status || Valley Med Urgent Care PLLC || Providers || TRPN ||  Provider Juan Hernandez is Active, effective date 07/23/2021,  Provider Nubia Benavides is Active, effective date 10/29/2021,  Provider Edna Michi is Active, effective date 10/29/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940', NULL, NULL, '2021-11-17 10:55:36', '2021-11-17 10:55:36'),
(46494, 1006, 31386, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46495, 1005, 31386, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s Enrollment.', NULL, NULL, '2021-06-04 09:37:33', '2021-06-04 09:37:33'),
(46496, 3040, 31386, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in 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: Hernandez, Juan Provider NPI# 1225617558  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-12 10:51:06', '2021-07-12 10:51:06'),
(46497, 3040, 31386, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Re: Enroll Provider || Valley Med Urgent Care PLLC || Hernandez, Juan || Driscoll ||   Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in Driscoll in 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: Hernandez, Juan Provider NPI# 1225617558  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 15:06:58', '2021-09-01 15:06:58'),
(46498, 10057, 31386, 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 14:34:38', '2021-11-08 14:34:38'),
(46499, 10057, 31386, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Forms needs to submit.', NULL, NULL, '2021-12-01 16:04:37', '2021-12-01 16:04:37'),
(46500, 10057, 31386, 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 10:56:24', '2021-12-14 10:56:24'),
(46501, 10057, 31386, 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 10:27:45', '2021-12-21 10:27:45'),
(46502, 10057, 31386, 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 13:09:27', '2021-12-28 13:09:27'),
(46503, 20067, 31386, 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 13:23:50', '2022-01-05 13:23:50'),
(46504, 20067, 31386, 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 12:24:09', '2022-01-18 12:24:09'),
(46505, 20067, 31386, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub: Karla.Claunch@dchstx.org  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 18:00:34', '2022-01-28 18:00:34'),
(46506, 20067, 31386, 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 11:22:03', '2022-02-04 11:22:03'),
(46507, 22077, 31386, NULL, '2022-04-14 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 ||  Hi Karla,  I would like to know the enrollment process for the following provider  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  Thanks. ', NULL, NULL, '2022-04-07 14:48:16', '2022-04-07 14:48:16'),
(46508, 1006, 31387, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46509, 3040, 31387, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Providers Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under 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 Name: Hernandez, Juan Alonso Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 11:59:28', '2021-06-04 11:59:28'),
(46510, 3040, 31387, NULL, '2021-06-22 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-15 13:24:02', '2021-06-15 13:24:02'),
(46511, 11056, 31387, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST || Valley Med Urgent Care PLLC || Christus Spohn ||  Greetings,  Kindly respond soon. Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Valley Med Urgent Care PLLC under 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      Providers: Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Provider 12: Provider Name: Hernandez, Juan Provider NPI#: 1225617558  Please get back to me as soon as possible. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 13:37:57', '2021-07-01 13:37:57'),
(46512, 3040, 31387, NULL, '2021-07-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject;:Enroll Group & Providers || Valley Med Urgent Care PLLC || USFHP|  Adil,  CHRISTUS Health Plan and CHRISTUS Spohn Health Network are two separate health plans…  I work for CHRISTUS Health Plan.  This is the service area Vicki at Spohn sent you in an email last week… I don’t see Cameron listed.', NULL, NULL, '2021-07-08 16:56:35', '2021-07-08 16:56:35'),
(46513, 1006, 31388, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46514, 1005, 31388, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-04 09:16:38', '2021-06-04 09:16:38'),
(46515, 3040, 31388, NULL, '2021-06-21 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.   ', NULL, NULL, '2021-06-14 15:57:04', '2021-06-14 15:57:04');
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
(46516, 3040, 31388, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com   Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned 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:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-07-20 14:04:22', '2021-07-20 14:04:22'),
(46517, 3040, 31388, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,  Please advise the enrollment status for the below mentioned group in Cigna Healthspring 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:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,   Thanks  ', NULL, NULL, '2021-07-28 14:32:29', '2021-07-28 14:32:29'),
(46518, 3040, 31388, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I sent the emails which are mentioned on the letter of interest form but I couldn\'t get any reply from their side. Can you please check the status and advise?  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:101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Tertiary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your reply,  Thank you  ', NULL, NULL, '2021-08-17 09:36:57', '2021-08-17 09:36:57'),
(46519, 10057, 31388, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned groups as we have submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails and let me know the current status of our application.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Please feel free to contact or email me if you have any questions or concerns.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:06:20', '2021-10-08 11:06:20'),
(46520, 10057, 31388, NULL, '2021-11-22 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com, TXGQProviderRelations@healthspring.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you well. I want to know the enrollment status for the below mentioned providers under these 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 Hernandez, Juan	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-15 17:49:55', '2021-11-15 17:49:55'),
(46521, 10057, 31388, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Can I get the latest update on the below mentioned request.  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-30 12:00:23', '2021-11-30 12:00:23'),
(46522, 10057, 31388, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope this email finds you in good health. I want to know the enrollment status for 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 Jeniece K  Wert	1659919702 Larry  Wright	1033769765 Teresa  Saavedra	1255676151 Eder  Hernandez	1386956852 Homero  Garcia	1730564857 Deborah  Potter	1861914053 Diego  Naranjo	1568929800 Mayra  Lopez	1265945125  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 17:41:21', '2021-12-06 17:41:21'),
(46523, 10057, 31388, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com, TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hey,  I\'m writing this email to check the current status on the below mentioned request. This is my second reminder.  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-13 12:46:26', '2021-12-13 12:46:26'),
(46524, 10057, 31388, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello Steve,  The last Letter of Interest that was submitted to Valley Organized Physicians/LVPA was in October of 2018. The LVPA Board of Directors determined that there was no network need and appropriate communication was provided via mail. If the group would like to be reconsidered, please fill out the attached LOI and we can make sure to review during our January 2022 Board of Directors meeting. I is going to be important that you list out all locations as well.  Please let me know if you have any other questions.  Thank you, Iliana', NULL, NULL, '2021-12-20 11:48:32', '2021-12-20 11:48:32'),
(46525, 10057, 31388, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : iliana.cortez@careallies.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Thank you for reaching out. Please find the attached LOI for groups and providers.  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 Juan Hernandez	1225617558 Wert, Jeniece K	1659919702 Wright, Larry	1033769765 Saavedra, Teresa	1255676151 Hernandez, Eder	1386956852 Garcia, Homero	1730564857 Potter, Deborah	1861914053 Naranjo, Diego	1568929800 Lopez, Mayra	1265945125 Escobar, Angiollet	1962917997 Rodriguez, Cynthia	1124282553  Please revert back to me once you have the update. Have a great day!  Regards,', NULL, NULL, '2021-12-27 11:07:28', '2021-12-27 11:07:28'),
(46526, 20067, 31388, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Subject: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hello Good Morning,  Hope you are doing well. I want to know the enrollment status for 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 Jeniece Wert	1659919702 Cynthia Rodriguez	1124282553 Deborah Potter	1861914053 Larry Wright	1033769765 Teresa Saavedra	1255676151 Diego Naranjo	1568929800 Eder Hernandez	1386956852 Homero Garcia	1730564857 Angiollet Escobar	1962917997 Mayra Lopez	1265945125   Thanks and Regards, Syed Ahad.  ', NULL, NULL, '2022-01-05 12:44:27', '2022-01-05 12:44:27'),
(46527, 20067, 31388, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Hello Syed,     I emailed Steve Albert, but the email bounced back.     We will be meeting with our LVPA and HOPE Board of Directors the week of the  24th where we will be discussing your group. Please fill out 1 LOI for the group with all location listed.  Please email me with any questions that you may have.     Thank you.     Iliana', NULL, NULL, '2022-01-11 13:54:55', '2022-01-11 13:54:55'),
(46528, 20067, 31388, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring  Good afternoon,  Hope all is well with you. The LOI form which you sent me doesn\'t have fields for additional locations. Kindly see the attachment below  Eagerly waiting to hear from you   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 14:01:55', '2022-01-11 14:01:55'),
(46529, 20067, 31388, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Thank you for the updated LOI. I added all locations. We meet with our Board of Directors on January 24th. Will be InTouch. ', NULL, NULL, '2022-01-11 17:47:26', '2022-01-11 17:47:26'),
(46530, 20067, 31388, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Will follow-up next week because the meeting of Board of Directors will be on  24th January', NULL, NULL, '2022-01-18 10:59:06', '2022-01-18 10:59:06'),
(46531, 20067, 31388, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: iliana.cortez@careallies.com  Sub: Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Good Evening! Hope this email finds you well. Any updates on the request?  Eagerly waiting to hear from you, Thanks and Regards,', NULL, NULL, '2022-01-28 17:52:59', '2022-01-28 17:52:59'),
(46532, 20067, 31388, NULL, '2022-02-11 00:00:00.000', 'Not Eligible', 'Email received from: dulce.lumbrera@careallies.com  Sub:  Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring   Hi Syed,  Thank you for reaching out. Please see attached for a response to the letter of interest that was presented at the Board of Director meeting. Thank you', NULL, NULL, '2022-02-04 10:43:29', '2022-02-04 10:43:29'),
(46533, 1006, 31389, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46534, 3040, 31389, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider  ', NULL, NULL, '2021-06-04 11:42:05', '2021-06-04 11:42:05'),
(46535, 1006, 31390, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46536, 3040, 31390, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Provider Enrollment || Valley Med Urgent Care PLLC || Hernandez, Juan Alonso || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and provider in Triwest for our group Valley Med Urgent Care PLLC under all three 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: Hernandez, Juan Alonso Provider NPI# 1225617558  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-04 14:42:01', '2021-06-04 14:42:01'),
(46537, 3040, 31390, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group enrollment request sent. Please see group task. ', NULL, NULL, '2021-06-18 15:39:04', '2021-06-18 15:39:04'),
(46538, 3040, 31390, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task.  ', NULL, NULL, '2021-07-16 11:34:52', '2021-07-16 11:34:52'),
(46539, 1006, 31391, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:21', '2021-06-03 17:40:21'),
(46540, 3040, 31391, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-06-04 11:22:06', '2021-06-04 11:22:06'),
(46541, 1006, 31393, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:22', '2021-06-03 17:40:22'),
(46542, 3040, 31393, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more detail please see group task.  ', NULL, NULL, '2021-06-04 15:00:17', '2021-06-04 15:00:17'),
(46543, 3040, 31393, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: rbyrd@wellmed.net  Subject: Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Hello Rhonda,   Please advise the status of an additional location that was requested in the previous email. I already sent the credentialing form for an additional location along with W9.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:22:18', '2021-07-20 09:22:18'),
(46544, 3040, 31393, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: contracthelpdesk@wellmed.net  Subject: Secure Message from contracthelpdesk@wellmed.net   Hello Erica & CHD,   Hope you are doing well. This is a follow up email regarding the status for additional location in our Valley Med Urgent Care PLLC. Has there been any update?   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 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-17 09:20:19', '2021-08-17 09:20:19'),
(46545, 3040, 31393, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: EriHernandez@wellmed.net, contracthelpdesk@wellmed.net  Subject: RE: [EXTERNAL] Re: [EXTERNAL] Re: Valley Med Urgent Care PLLC - TIN 81-5123542  Good morning Erica ,  I sow the location was added as of 06/01/2021  WellMed-Horz_no tagline_COLOR logo_SIG ____________________________  Joe Gallegos Contract Specialist WellMed Medical Management, Inc.', NULL, NULL, '2021-08-27 09:16:49', '2021-08-27 09:16:49'),
(46546, 1006, 31403, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:22', '2021-06-03 17:40:22'),
(46547, 3040, 31403, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'enaissance Physicians does not cover Brownsville or McAllen, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-06-04 11:23:10', '2021-06-04 11:23:10'),
(46548, 1006, 31404, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:22', '2021-06-03 17:40:22'),
(46549, 1005, 31404, NULL, '2021-06-11 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-04 09:18:46', '2021-06-04 09:18:46'),
(46550, 3040, 31404, NULL, '2021-06-11 00:00:00.000', 'Approved', 'Facility has an ancillary contract. No need to add individual providers. Facility contract attached in group task.  ', NULL, NULL, '2021-06-04 11:20:45', '2021-06-04 11:20:45'),
(46551, 1006, 31405, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-03 17:40:22', '2021-06-03 17:40:22'),
(46552, 3040, 31405, NULL, '2021-06-11 00:00:00.000', 'Not Eligible', 'Email rcvd from: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Hello Adil, I hope you are doing well too!  Please review the letter attached and let me know if you have any questions.  Best regards, Michal  Ms. Michal Simms Network Contractor Senior Nueces Region CHRISTUS Health Plan US Family Health Plan (o) 469-282-3227 www.christushealthplan.org  Please see attachment in group task. ', NULL, NULL, '2021-06-04 11:27:12', '2021-06-04 11:27:12'),
(46553, 3040, 31408, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-04 13:23:09', '2021-06-04 13:23:09'),
(46554, 3040, 31408, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-06-04 13:54:53', '2021-06-04 13:54:53'),
(46555, 3040, 31408, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Greetings,  I wanted to know the enrollment status for the below mentioned provider in 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: Hernandez, Juan Provider NPI# 1225617558  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 09:23:07', '2021-06-21 09:23:07'),
(46556, 3040, 31408, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Provider Application – Hernandez  Hello,  Hope you are doing well. Please advise the enrollment status for the below mentioned provider in 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: Hernandez, Juan Provider NPI# 1225617558  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-07-05 10:52:28', '2021-07-05 10:52:28'),
(46557, 3040, 31408, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Provider Application – Hernandez  Hi,  Provider \'\' Hernandez, Juan A PA \'\' is Effective \'\' 08/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :81311)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-07-23 13:57:52', '2021-07-23 13:57:52'),
(46558, 3040, 31408, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject:  Provider Application – Hernandez  Hello,   Hope you are doing well. Please note that I checked the Health Smart provider directory and the provider is not showing up in the directory. Can you please check and advise?  Please get back to me as soon as you can get a chance. Waiting for your reply.   Thank you ', NULL, NULL, '2021-07-23 13:58:25', '2021-07-23 13:58:25'),
(46559, 3040, 31408, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Fw: Provider Application – Hernandez  Greetings,  Hope you are doing well. Please note that I checked the Health smart provider directory and it shows the provider is participating at the primary location which is 2534 Boca Chica Blvd Brownsville TX 78521 and the remaining 02 which is 800 E Alton Gloor Blvd Brownsville , TX 78526 & 101 E Expressway 83, Suite 170 Mcallen TX 78501 locations are not showing in the directory. Can you please check & advise?   Thank you ', NULL, NULL, '2021-08-30 14:19:53', '2021-08-30 14:19:53'),
(46560, 10057, 31408, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Providers Application – Health Smart  Good Evening,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in 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 Luyando, Mariana	1700960556 Hernandez, Juan	1225617558 Potter, Deborah	1861914053  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-14 16:08:41', '2021-10-14 16:08:41'),
(46561, 10057, 31408, NULL, '2021-11-12 00:00:00.000', 'Approved', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Providers Application – Health Smart  Hi,  01- Please see the following Providers with effective dates.  Provider Name   Effective Date   Juan A Hernandez, PA  08/01/2021   Deborah Potter, NP  06/01/2021   02- We are returning your application due to missing information listed below.  Provider Name   Missing Information   LUYANDO, MARIANA PA   Current certificate of Insurance.   Please review the attached Application Review Form and forward the missing information within the next 5 days. Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-05 13:40:20', '2021-11-05 13:40:20'),
(46562, 1006, 31409, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46563, 1006, 31409, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Ancillary enrollment is in-process in the main group task, please check it for further information. ', NULL, NULL, '2021-06-07 14:14:13', '2021-06-07 14:14:13'),
(46564, 11056, 31409, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Query - BHUCC - Cigna Healthspring  Good Evening,  Hope you are doing well. I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is? Kindly respond to us 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  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you!', NULL, NULL, '2021-07-12 14:44:36', '2021-07-12 14:44:36'),
(46565, 11056, 31409, NULL, '2021-07-20 00:00:00.000', 'On Hold', 'Ancillary enrollment is in-process in the main group task, please check it for further information. ', NULL, NULL, '2021-07-12 14:45:42', '2021-07-12 14:45:42'),
(46566, 1006, 31410, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46567, 1006, 31410, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Our request is in-process but we still haven\'t received a contract and it is based on the need for providers and the amount of VA patients in the area, we need to wait until we are eligible. Need to wait until we receive a contract from them to proceed with this application.  Ref# Kate 06/07/2021', NULL, NULL, '2021-06-07 11:41:51', '2021-06-07 11:41:51'),
(46568, 1006, 31411, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46569, 1006, 31411, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment as it does not cover the state and as per our discussion with the billing teams.', NULL, NULL, '2021-06-07 09:16:54', '2021-06-07 09:16:54'),
(46570, 1006, 31418, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46571, 1006, 31418, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Missouri City for enrollment requests. We cannot move forward.', NULL, NULL, '2021-06-07 10:58:10', '2021-06-07 10:58:10'),
(46572, 1006, 31419, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46573, 1006, 31419, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. Information is listed on main Molina task for reference. ', NULL, NULL, '2021-06-07 11:03:59', '2021-06-07 11:03:59'),
(46574, 1006, 31420, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:32', '2021-06-07 08:43:32'),
(46575, 1006, 31420, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Hello Michal, I hope you\'re doing well, we wish to enroll the following group and providers with Christus Health, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please let me know what is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-06-07 10:49:30', '2021-06-07 10:49:30'),
(46576, 1006, 31420, NULL, '2021-06-22 00:00:00.000', 'In Process', 'We received the following reply from Hunter Barrett hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Brad,  Does the urgent care bill on a professional level, billing with the individuals NPI or as the group NPI?  Thanks,\"  Gave them the following reply: \"Good morning Hunter,   The urgent care bills with individual NPI\'s. Also, we want one of the providers to be listed as a PCP, is that possible?  Thank you.\"', NULL, NULL, '2021-06-15 08:06:10', '2021-06-15 08:06:10'),
(46577, 1006, 31420, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Does the provider have a separate office?  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org\"  Replied with:   \"Hello Hunter,  I apologize for the delay, but no the provider will be working in the same office. Please let me know if there\'s any way to enroll her as a PCP.  Thank you. \"', NULL, NULL, '2021-07-05 16:54:35', '2021-07-05 16:54:35'),
(46578, 11056, 31420, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Brad,   After talking with my manager, we cannot contract with an Urgent Care Center with a group contract, the only way the center can become in network is with an Ancillary contract and only the group NPI will show up as in network and can only bill as the group NPI.   Thanks, Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org', NULL, NULL, '2021-07-19 10:37:30', '2021-07-19 10:37:30'),
(46579, 11056, 31420, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Good Afternoon!  Hope you are doing well. Ok, then kindly inform me with Ancillary contract procedure and guide me with that properly soon. What steps do I have to take and which documents you required for enrollment in the Ancillary contract?  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 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-26 15:48:21', '2021-07-26 15:48:21'),
(46580, 11056, 31420, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,  I apologize, I thought I sent the documents. Here is the contract and application needed.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan  CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org', NULL, NULL, '2021-07-29 17:06:05', '2021-07-29 17:06:05'),
(46581, 11056, 31420, NULL, '2021-08-11 00:00:00.000', 'In Process', '	 Email sent to : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope you are doing well. Here is the filled contract/agreement and application forms for the providers and practice 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  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-03 15:18:40', '2021-08-03 15:18:40'),
(46582, 11056, 31420, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,   Do you have a copy of the W9?   Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan  CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-10 08:31:46', '2021-08-10 08:31:46'),
(46583, 11056, 31420, NULL, '2021-09-02 00:00:00.000', 'In Process', 'The request will take 6 months because their credentialing team is packed with some old providers and work, it will take 6 months to enroll new providers..', NULL, NULL, '2021-08-25 17:03:05', '2021-08-25 17:03:05'),
(46584, 11056, 31420, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope this email finds you well. It\'s been a long time sir, that you haven\'t responded to my emails. Please inform me about the enrollment status of the mentioned below providers and Practice.  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 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-31 16:21:20', '2021-08-31 16:21:20'),
(46585, 11056, 31420, NULL, '2021-10-04 00:00:00.000', 'On Hold', 'Email received from : hunter.barrett@christushealth.org  &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health   I have been on Vacation. Contract was sent to credentialing at the beginning of August. They hast to give them 6 months to process new applications.', NULL, NULL, '2021-09-27 08:26:37', '2021-09-27 08:26:37'),
(46586, 1006, 31421, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46587, 1006, 31421, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'We submitted an ancillary enrollment request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - BHUCC - Cigna Healthspring  \"Hello,  Please find the attached enrollment form for our ancillary group, please let me know if anything else is required to proceed with the enrollment. Thank you. \"  Form is attached for reference. ', NULL, NULL, '2021-06-07 14:13:41', '2021-06-07 14:13:41'),
(46588, 1006, 31421, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ TXMAContracting@cigna.com:  Sub: Enrollment Request - BHUCC - Cigna Healthspring  \"Hello,  I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is?  Thank you.\"', NULL, NULL, '2021-06-24 13:45:54', '2021-06-24 13:45:54'),
(46589, 11056, 31421, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Query - BHUCC - Cigna Healthspring  Good Evening,  Hope you are doing well. I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is? Kindly respond to us 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  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you!', NULL, NULL, '2021-07-12 14:44:16', '2021-07-12 14:44:16'),
(46590, 11056, 31421, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring   Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is? Kindly respond to us 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  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 13:10:18', '2021-07-19 13:10:18'),
(46591, 11056, 31421, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to :  txgqproviderrelations@healthspring.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Good morning!  Hope you are doing well. I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is? Kindly respond to us 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  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 13:29:20', '2021-07-30 13:29:20'),
(46592, 11056, 31421, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Ahmed,     Are you seeking enrollment for Renaissance Physicians     Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-03 15:35:37', '2021-08-03 15:35:37'),
(46593, 11056, 31421, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Good morning Jennifer!  Hope you are doing well. No, I want to enroll the below mentioned Practice in Cigna Healthspring.  Please assist us 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  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you! Have a great day! ', NULL, NULL, '2021-08-10 09:45:15', '2021-08-10 09:45:15'),
(46594, 11056, 31421, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  HI Ahmed,     I’m unsure if you received my previous message, however in order to enroll in Cigna-Medicare we would need the following form filled out. We would need this for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC.        Thank you,', NULL, NULL, '2021-08-16 16:16:50', '2021-08-16 16:16:50'),
(46595, 11056, 31421, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Good Afternoon Jennifer!  Hope all is well. Here are the filled Practitioner network interest forms for the providers and practice enrollment. Please see the attachments.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice NPI# :1013540962 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Providers Details: Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612   Furthermore, If any additional information or documents are needed feel free to reach out to me. Waiting to hear from you soon.   Thank You! Have a great day!', NULL, NULL, '2021-08-23 14:37:43', '2021-08-23 14:37:43'),
(46596, 11056, 31421, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Great! I will send this to our network committee, and they will be able to review your application towards the end of the month.', NULL, NULL, '2021-08-31 11:27:12', '2021-08-31 11:27:12'),
(46597, 11056, 31421, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Good morning!  Hope you are doing well. Have my applications been reviewed ? Could you Please let me know the current status of our Credentialing request? I have mentioned the details below of our group and providers :  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice NPI# :1013540962 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Providers Details: Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612   Furthermore, If any additional information or documents are needed feel free to reach out to me. Waiting to hear from you soon.   Thank You! Have a great day! ', NULL, NULL, '2021-09-08 16:57:00', '2021-09-08 16:57:00'),
(46598, 11056, 31421, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring   Hi Ahmad,  Your application has been reviewed and you will be receiving a denial letter within the next few weeks.    Thank you!   Asked the reason, but not get the reply yet.', NULL, NULL, '2021-09-24 16:44:41', '2021-09-24 16:44:41'),
(46599, 11056, 31421, NULL, '2021-10-12 00:00:00.000', 'On Hold', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  Hi Ahmad,  Your application has been reviewed and you will be receiving a denial letter within the next few weeks.    Thank you!    Another Email received from : JENNIFER.PEREZ@cigna.com  Hi Ahmed,  The network committee issued a denial due to a no network need. You may re-apply in another year if your practice is still interested in becoming credentialed. Please let me know if you have any other questions.  Thank you.   ', NULL, NULL, '2021-10-05 15:55:45', '2021-10-05 15:55:45'),
(46600, 1006, 31422, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46601, 1006, 31422, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Our request is in-process but we still haven\'t received a contract and it is based on the need for providers and the amount of VA patients in the area, we need to wait until we are eligible. Need to wait until we receive a contract from them to proceed with this application.  Ref# Kate 06/07/2021', NULL, NULL, '2021-06-07 11:41:45', '2021-06-07 11:41:45'),
(46602, 1006, 31423, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46603, 1006, 31423, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment as it does not cover the state and as per our discussion with the billing teams.', NULL, NULL, '2021-06-07 09:17:03', '2021-06-07 09:17:03'),
(46604, 1006, 31430, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46605, 1006, 31430, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Missouri City for enrollment requests. We cannot move forward.', NULL, NULL, '2021-06-07 10:58:05', '2021-06-07 10:58:05'),
(46606, 1006, 31431, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46607, 1006, 31431, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. Information is listed on main Molina task for reference. ', NULL, NULL, '2021-06-07 11:03:54', '2021-06-07 11:03:54'),
(46608, 1006, 31432, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 08:43:37', '2021-06-07 08:43:37'),
(46609, 1006, 31432, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Hello Michal, I hope you\'re doing well, we wish to enroll the following group and providers with Christus Health, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please let me know what is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-06-07 10:49:25', '2021-06-07 10:49:25'),
(46610, 1006, 31432, NULL, '2021-06-22 00:00:00.000', 'In Process', 'We received the following reply from Hunter Barrett hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Brad,  Does the urgent care bill on a professional level, billing with the individuals NPI or as the group NPI?  Thanks,\"  Gave them the following reply: \"Good morning Hunter,   The urgent care bills with individual NPI\'s. Also, we want one of the providers to be listed as a PCP, is that possible?  Thank you.\"', NULL, NULL, '2021-06-15 08:05:59', '2021-06-15 08:05:59'),
(46611, 1006, 31432, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Does the provider have a separate office?  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org\"  Replied with:   \"Hello Hunter,  I apologize for the delay, but no the provider will be working in the same office. Please let me know if there\'s any way to enroll her as a PCP.  Thank you. \"', NULL, NULL, '2021-07-05 16:54:28', '2021-07-05 16:54:28'),
(46612, 11056, 31432, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Brad,   After talking with my manager, we cannot contract with an Urgent Care Center with a group contract, the only way the center can become in network is with an Ancillary contract and only the group NPI will show up as in network and can only bill as the group NPI.   Thanks, Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org', NULL, NULL, '2021-07-19 10:37:14', '2021-07-19 10:37:14'),
(46613, 11056, 31432, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Good Afternoon!  Hope you are doing well. Ok, then kindly inform me with Ancillary contract procedure and guide me with that properly soon. What steps do I have to take and which documents you required for enrollment in the Ancillary contract?  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 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-26 15:48:07', '2021-07-26 15:48:07'),
(46614, 11056, 31432, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,  I apologize, I thought I sent the documents. Here is the contract and application needed.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan  CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org', NULL, NULL, '2021-07-29 17:05:42', '2021-07-29 17:05:42'),
(46615, 11056, 31432, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope you are doing well. Here is the filled contract/agreement and application forms for the providers and practice 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  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-03 15:18:09', '2021-08-03 15:18:09');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(46616, 11056, 31432, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope you are doing well. Here is the filled contract/agreement and application forms for the providers and practice 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  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-03 15:18:09', '2021-08-03 15:18:09'),
(46617, 11056, 31432, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,   Do you have a copy of the W9?   Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan  CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-10 08:27:21', '2021-08-10 08:27:21'),
(46618, 11056, 31432, NULL, '2021-09-02 00:00:00.000', 'In Process', 'The request will take 6 months because their credentialing team is packed with some old providers and work, it will take 6 months to enroll new providers..', NULL, NULL, '2021-08-25 17:02:57', '2021-08-25 17:02:57'),
(46619, 11056, 31432, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope this email finds you well. It\'s been a long time sir, that you haven\'t responded to my emails. Please inform me about the enrollment status of the mentioned below providers and Practice.  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 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-31 16:21:02', '2021-08-31 16:21:02'),
(46620, 11056, 31432, NULL, '2021-10-04 00:00:00.000', 'On Hold', 'Email received from : hunter.barrett@christushealth.org  &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health   I have been on Vacation. Contract was sent to credentialing at the beginning of August. They hast to give them 6 months to process new applications.', NULL, NULL, '2021-09-27 08:27:06', '2021-09-27 08:27:06'),
(46621, 19067, 31432, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email received from: latasha.newton2@christushealth.org  Subject: Executed AGREEMENT    Hello,     I have attached the executed agreement for Best Health Urgent Care.  Please review and if you have any further questions feel free to email back to this email address.        Thank You        LaTasha Newton  Network Contract Coordinator  CHRISTUS Health Plan  (o) 469.282.3024  www.christushealthplan.org', NULL, NULL, '2022-03-16 16:33:53', '2022-03-16 16:33:53'),
(46622, 19067, 31432, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Email received from: latasha.newton2@christushealth.org  Subject: Executed AGREEMENT    Hello     The effective date is on the contract. It is 1/1/2022.', NULL, NULL, '2022-03-21 09:58:50', '2022-03-21 09:58:50'),
(46623, 3040, 31433, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46624, 3040, 31433, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response.', NULL, NULL, '2021-06-08 08:17:24', '2021-06-08 08:17:24'),
(46625, 3040, 31433, NULL, '2021-06-18 00:00:00.000', 'In Process', 'View Summary Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 311863', NULL, NULL, '2021-06-11 12:53:32', '2021-06-11 12:53:32'),
(46626, 3040, 31433, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application no 311863 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly, Jacob, Jaya & PAUL, SIGI || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in BCBS for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-29 12:56:49', '2021-06-29 12:56:49'),
(46627, 3040, 31433, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : NORMANDY URGENT CARE CENTER PA Group Record Id : H00032WN01  Provider Name : MOLLY JOSEPH Provider Record Number : H08PR75201', NULL, NULL, '2021-07-14 14:30:23', '2021-07-14 14:30:23'),
(46628, 3040, 31434, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46629, 3040, 31434, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-06-07 18:08:03', '2021-06-07 18:08:03'),
(46630, 3040, 31435, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46631, 3040, 31435, NULL, '2021-06-14 00:00:00.000', 'Approved', 'We have an ancillary contract with Cigna, attached for reference.  ', NULL, NULL, '2021-06-07 18:10:41', '2021-06-07 18:10:41'),
(46632, 3040, 31436, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46633, 3040, 31436, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:networkhelp@uhc.com  Subject;Enroll Providers ||Normandy Urgent Care Center , Imperial Valley Urgent Care Center & Longpoint Medical Center || Providers || UHC ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:14:09', '2021-06-07 19:14:09'),
(46634, 3040, 31436, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from andrew_vinson@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry.  Provider, Joseph, Molly, NPI: 1396380077, not linked to tin, not credentialed, non-participating. Follow steps below to credential provider.  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.   Andrew Vinson UnitedHealth Care Network Management Resource Team', NULL, NULL, '2021-06-24 16:55:09', '2021-06-24 16:55:09'),
(46635, 3040, 31436, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly || UHC ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-13 11:41:51', '2021-07-13 11:41:51'),
(46636, 3040, 31436, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from; networkhelp@uhc.com  Subject: Secure Message from gregory.s.carte@optum.com  Thank you for contacting the Network Management Resource Team. The group’s contract does not require the providers to be credentialed or to have contract lines loaded to their individual records. The provider only has to be demographically linked to the TIN. I show that the provider is linked to the TIN as of 7/12/2021 for both of your Urgent Care Facilities.  Please let us know if we can assist further via email.   Sincerely,  Greg Carte UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-14 14:51:17', '2021-07-14 14:51:17'),
(46637, 3040, 31437, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46638, 1005, 31437, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:55:31', '2021-06-07 16:55:31'),
(46639, 3040, 31437, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-15 09:08:17', '2021-07-15 09:08:17'),
(46640, 3040, 31437, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:38:56', '2021-07-26 16:38:56'),
(46641, 11056, 31437, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:20:31', '2021-08-13 15:20:31'),
(46642, 3040, 31437, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:34', '2021-08-26 08:45:34'),
(46643, 10057, 31437, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:41:37', '2021-10-08 13:41:37'),
(46644, 10057, 31437, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:08:01', '2021-10-21 11:08:01'),
(46645, 10057, 31437, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:44:10', '2021-10-29 09:44:10'),
(46646, 10057, 31437, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:31:39', '2021-11-22 13:31:39'),
(46647, 10057, 31437, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:21:15', '2021-12-02 14:21:15'),
(46648, 10057, 31437, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:50:02', '2021-12-09 11:50:02'),
(46649, 10057, 31437, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:49:41', '2021-12-16 14:49:41'),
(46650, 10057, 31437, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:46:35', '2021-12-22 13:46:35'),
(46651, 10057, 31437, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:01:38', '2021-12-29 12:01:38'),
(46652, 20067, 31437, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:31', '2022-01-12 14:57:31'),
(46653, 20067, 31437, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:55:29', '2022-01-19 09:55:29'),
(46654, 20067, 31437, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:25:56', '2022-01-28 10:25:56'),
(46655, 20067, 31437, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:41', '2022-03-01 15:26:41'),
(46656, 22077, 31437, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:59:49', '2022-04-18 11:59:49'),
(46657, 3040, 31438, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46658, 3040, 31438, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Humana ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-08 08:31:28', '2021-06-08 08:31:28'),
(46659, 3040, 31438, NULL, '2021-06-15 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-06-08 08:41:00', '2021-06-08 08:41:00'),
(46660, 3040, 31439, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46661, 1005, 31439, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:41', '2021-06-07 16:49:41'),
(46662, 3040, 31439, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com, txcredentialing@amerigroup.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Amerigroup ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Amerigroup in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:41:16', '2021-07-15 08:41:16'),
(46663, 3040, 31439, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Jason.Hughes@amerigroup.com,  Subject: Enrollment Status || Normandy Urgent Care Center - Amerigroup  Hello Jason,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-26 15:24:12', '2021-07-26 15:24:12'),
(46664, 11056, 31439, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : Jason.Hughes@amerigroup.com   &   TX Credentialing TXCredentialing@amerigroup.com  Sub : Fwd: Delivery Status Notification (Failure)  Good afternoon Jason!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 14:13:40', '2021-08-13 14:13:40'),
(46665, 3040, 31439, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:48', '2021-08-25 14:59:48'),
(46666, 3040, 31439, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:58', '2021-09-09 13:07:58'),
(46667, 10057, 31439, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:15:20', '2021-10-18 15:15:20'),
(46668, 10057, 31439, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:00:01', '2021-11-11 13:00:01'),
(46669, 10057, 31439, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:47:44', '2021-11-30 10:47:44'),
(46670, 10057, 31439, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:03:31', '2021-12-06 16:03:31'),
(46671, 10057, 31439, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:47:21', '2021-12-13 10:47:21'),
(46672, 10057, 31439, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:53:37', '2021-12-20 13:53:37'),
(46673, 10057, 31439, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:06', '2021-12-27 09:54:06'),
(46674, 19067, 31439, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:03:27', '2022-01-04 16:03:27'),
(46675, 20067, 31439, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:47:55', '2022-01-14 10:47:55'),
(46676, 20067, 31439, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-24 17:09:11', '2022-01-24 17:09:11');
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
(46677, 20067, 31439, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  I added a column with my notes     Group Name  Normandy Urgent Care Center     Tax ID  27-0796429     Group NPI  1407171077     Provider Name  NPI  Location  AGP Notes  Jeny John  1073019493  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190140  Jeny John  1073019493  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Molly Joseph  1396380077  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Molly Joseph  1396380077  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Cini Thomas  1134777238  779 Normandy St STE 114, Houston, TX 77015-3441  Not par at this location, include phone and Fax  Cini Thomas  1134777238  16272 Imperial Valley DR STE K, Houston, TX 77060  -                                        Eff date 11/22/2021 P# 10869221  Ani Stephen  1588959118  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 12/20/2021.  P# 12190275  Ani Stephen  1588959118  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Abdur Rauf  1497726202  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 01641188  Abdur Rauf  1497726202  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 01641188  James Piccione JR  1356321509  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  James Piccione JR  1356321509  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  779 Normandy St STE 114, Houston, TX 77015-3441  Complete the attached LOI so I can link her to this tax ID  Sigi Paul  1033623616  16272 Imperial Valley DR STE K, Houston, TX 77060  Complete the attached LOI so I can link her to this tax ID  Odette Kourouma  1134525868  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190157  Odette Kourouma  1134525868  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Vibitha Joseph  1952931560  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12221497  Vibitha Joseph  1952931560  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12221497  Julie Jose  1447883061  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 09807037  Julie Jose  1447883061  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 09807037  Jaya Jacob  1194336149  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12205914  Jaya Jacob  1194336149  16272 Imperial Valley DR STE K, Houston, TX 77060  Eff date 11/11/2021.  P# 12205914  Jeemol George  1497219067  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 05/29/2020 (Amerivantage only) – 09805666   - not par at the Imperial Valley location, include the phone and fax  Limy Fernandus  1972005189  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190801  Limy Fernandus  1972005189  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Brittany Brown  1275163537  16272 Imperial Valley DR STE K, Houston, TX 77060  Effective 11/11/2021.  P# 09808410 (not par at the Imperial Valley location, include the phone and fax)  Jeena Abraham  1467901587  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 10286831  Jeena Abraham  1467901587  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax  Mini Chennemkara  1841755956  779 Normandy St STE 114, Houston, TX 77015-3441  Eff date 11/11/2021.  P# 12190610  Mini Chennemkara  1841755956  16272 Imperial Valley DR STE K, Houston, TX 77060  Not par at this location, include phone and Fax', NULL, NULL, '2022-01-24 17:15:01', '2022-01-24 17:15:01'),
(46678, 20067, 31439, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello,  Hope you had a good weekend. Can you please help me out with few queries mention below: What do I have to do to Par these providers at Imperial Valley Urgent Care Center?  Secondly, I can\'t locate Cini Thomas in the Amerigroup providers directory. Lastly, do I have to submit LOI for individual providers? Eagerly waiting for your reply, Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-02-02 14:43:47', '2022-02-02 14:43:47'),
(46679, 20067, 31439, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Afternoon!  Hope you are doing well. Attached are the LOI for the Non-Par Providers. Can you please tell me how I can add a location under the remaining providers?  Thank you,', NULL, NULL, '2022-03-01 13:37:42', '2022-03-01 13:37:42'),
(46680, 20067, 31439, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email received from: txcredentialing@amerigroup.com  Sub: FW: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Does this provider wish to be in the directory?  If so, please resend the lOI', NULL, NULL, '2022-03-18 17:01:31', '2022-03-18 17:01:31'),
(46681, 22077, 31439, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Subject: Re: {EXTERNAL} Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||  Hi,  Any update on the mentioned request?  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:59:06', '2022-04-14 13:59:06'),
(46682, 3040, 31440, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46683, 1005, 31440, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:50:15', '2021-06-07 16:50:15'),
(46684, 3040, 31440, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org, Rajika.Reid@communityhealthchoice.org  Subject:  Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. I wanted to follow up regarding the location addition status for below mentioned group. Also can you please send the copy of contract. I wanted to know if we have an ancillary contract do we need to enroll the providers separately or it will billed under the facility TIN?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 11:00:48', '2021-06-14 11:00:48'),
(46685, 11056, 31440, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,  Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you!', NULL, NULL, '2021-07-01 11:52:50', '2021-07-01 11:52:50'),
(46686, 3040, 31440, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:34:01', '2021-07-05 09:34:01'),
(46687, 3040, 31440, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:07', '2021-07-20 10:43:07'),
(46688, 11056, 31440, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:28:20', '2021-08-09 10:28:20'),
(46689, 3040, 31440, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:52', '2021-08-17 13:57:52'),
(46690, 3040, 31441, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46691, 1005, 31441, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:51:46', '2021-06-07 16:51:46'),
(46692, 11056, 31441, NULL, '2021-07-01 00:00:00.000', 'In Process', 'The enrollment form has been submitted for enrollment. Waiting for the contract. Please see the attachments.', NULL, NULL, '2021-06-23 14:41:54', '2021-06-23 14:41:54'),
(46693, 3040, 31441, NULL, '2021-07-19 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-07-12 16:22:48', '2021-07-12 16:22:48'),
(46694, 3040, 31442, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46695, 3040, 31442, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response.', NULL, NULL, '2021-06-08 08:17:47', '2021-06-08 08:17:47'),
(46696, 11056, 31442, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Enrollment form has been submitted. Please see the attachment. Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.', NULL, NULL, '2021-06-23 15:49:19', '2021-06-23 15:49:19'),
(46697, 3040, 31442, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent  to: pr.south@healthsmart.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Joseph, Molly || Health Smart ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-12 14:54:20', '2021-07-12 14:54:20'),
(46698, 11056, 31442, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com   &   mdiprsupport@healthsmart.com  Sub : Enrollment Status Query - NUCC - IUVC - Health smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : Joseph, Molly Provider NPI # : 1396380077  Provider Name : John, Jeny Provider NPI # : 1073019493  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:42:46', '2021-08-09 13:42:46'),
(46699, 11056, 31442, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com   &   mdiprsupport@healthsmart.com  Sub : Enrollment Status Query - NUCC - IUVC - Health smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : Joseph, Molly Provider NPI # : 1396380077  Provider Name : John, Jeny Provider NPI # : 1073019493  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:42:47', '2021-08-09 13:42:47'),
(46700, 3040, 31442, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Enrollment Status Query - NUCC - IUVC - Health smart  Hi,  1. \" JOSEPH, MOLLY \" is effective date \" 05/01/2021 \".', NULL, NULL, '2021-08-30 15:02:31', '2021-08-30 15:02:31'),
(46701, 3040, 31443, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46702, 3040, 31443, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Multiplan||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:56:19', '2021-06-07 18:56:19'),
(46703, 3040, 31443, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Multiplan ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 5:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 7:   Provider Name: Jose, Julie Provider NPI# 1447883061  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 11:49:01', '2021-06-17 11:49:01'),
(46704, 3040, 31443, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:14', '2021-07-06 11:57:14'),
(46705, 3040, 31443, NULL, '2021-07-22 00:00:00.000', 'Approved', 'I had a word with Shanda Multiplan representative and she advised the provider is participating with Multiplan.   Ref: 7612502', NULL, NULL, '2021-07-15 09:33:38', '2021-07-15 09:33:38'),
(46706, 3040, 31444, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46707, 1005, 31444, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:09', '2021-06-07 16:45:09'),
(46708, 11056, 31444, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Please see group task. ', NULL, NULL, '2021-06-16 12:50:45', '2021-06-16 12:50:45'),
(46709, 3040, 31445, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46710, 1005, 31445, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:42', '2021-06-07 16:45:42'),
(46711, 3040, 31445, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status       Submitted		 PEP Ticket Number 17867890 ', NULL, NULL, '2021-06-22 16:22:00', '2021-06-22 16:22:00'),
(46712, 3040, 31445, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Provider participating with Medicaid. Please see attachment. ', NULL, NULL, '2021-07-12 14:02:22', '2021-07-12 14:02:22'),
(46713, 3040, 31446, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46714, 1005, 31446, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Memorial Hermann enrollment is covered under Aetna plans, pending Aetna enrollment. ', NULL, NULL, '2021-06-07 16:52:58', '2021-06-07 16:52:58'),
(46715, 3040, 31446, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:39:25', '2021-06-16 16:39:25'),
(46716, 3040, 31446, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:08', '2021-07-20 10:52:08'),
(46717, 11056, 31446, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 16:14:39', '2021-08-12 16:14:39'),
(46718, 3040, 31446, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:23', '2021-08-27 10:00:23'),
(46719, 3040, 31448, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46720, 1005, 31448, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:01', '2021-06-07 16:54:01'),
(46721, 3040, 31448, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Greetings,   Hope you are doing well. Please find attached the contract request form along with the Letter of intent to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 09:03:55', '2021-07-15 09:03:55'),
(46722, 11056, 31448, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Good morning!   Hope you are doing well. I want to know the enrollment status of the below mentioned providers in Moilna Healthcare in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great week ahead! ', NULL, NULL, '2021-08-11 10:33:51', '2021-08-11 10:33:51'),
(46723, 3040, 31448, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Molina Heath ||  Hello Thomas,    Hope you are doing well. I wanted to enroll the below mentioned providers in Moilna Healthcare in our group under the below locations. Can you please advise the process?  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-18 15:11:23', '2021-08-18 15:11:23'),
(46724, 10057, 31448, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:25:47', '2021-10-08 11:25:47'),
(46725, 10057, 31448, NULL, '2021-11-22 00:00:00.000', 'Approved', '	 Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.   The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:29:05', '2021-11-15 10:29:05'),
(46726, 3040, 31449, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46727, 1005, 31449, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:55:00', '2021-06-07 16:55:00'),
(46728, 3040, 31449, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Superior Healthplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:32:06', '2021-07-15 08:32:06'),
(46729, 3040, 31449, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: shp.networkdevelopment@superiorhealthplan.com  Subject; NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,   Hope you are doing well. Please find attached the Individual provider contracting packet as per 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, '2021-07-22 14:21:06', '2021-07-22 14:21:06'),
(46730, 11056, 31449, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : NETOPS-ADMIN@centene.com  Sub : Fwd: NORMANDY URGENT CARE CENTER PA - Add provider  Dear Provider,     MOLLY JOSEPH     We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to shp.networkdevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.     To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.     Thank you,  Jeannie Lopez  Network Management & Contracting Department – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-12 09:49:32', '2021-08-12 09:49:32'),
(46731, 3040, 31449, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: NORMANDY URGENT CARE CENTER PA - Add provider  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Healthplan in our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 11:56:38', '2021-08-27 11:56:38'),
(46732, 10057, 31449, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:53:30', '2021-10-18 09:53:30'),
(46733, 10057, 31449, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:40:57', '2021-11-22 11:40:57'),
(46734, 10057, 31449, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:06:41', '2021-11-23 10:06:41'),
(46735, 10057, 31449, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 10:50:22', '2021-12-03 10:50:22'),
(46736, 10057, 31449, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:54:55', '2021-12-10 14:54:55'),
(46737, 10057, 31449, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:58:29', '2021-12-17 10:58:29'),
(46738, 10057, 31449, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:53:39', '2021-12-23 10:53:39'),
(46739, 10057, 31449, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:17:15', '2021-12-30 13:17:15'),
(46740, 19067, 31449, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:48:05', '2022-01-03 17:48:05'),
(46741, 20067, 31449, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:22:24', '2022-01-12 15:22:24'),
(46742, 19067, 31449, NULL, '2022-01-20 00:00:00.000', 'Approved', 'Effective date: 01/01/2022. See attachment for Welcome Letter.', NULL, NULL, '2022-01-13 14:16:24', '2022-01-13 14:16:24'),
(46743, 19067, 31449, NULL, '2022-01-20 00:00:00.000', 'Approved', 'MOLLY JOSEPH NORMANDY URGENT CARE CENTER PA ASK@CLAIMSMEDINC.COM  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high-quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members. Your Amendment effective date is: 01/01/2022 C/ 54403', NULL, NULL, '2022-01-13 14:55:15', '2022-01-13 14:55:15'),
(46744, 3040, 31450, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46745, 3040, 31450, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers ||Normandy Urgent Care Center , Imperial Valley Urgent Care Center & Longpoint Medical Center || Providers || Tricare ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:43:38', '2021-06-07 18:43:38'),
(46746, 3040, 31450, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:41:05', '2021-06-22 09:41:05'),
(46747, 3040, 31450, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Provider certification application form sent @ (608) 221-7535. Please see attachment. ', NULL, NULL, '2021-07-12 13:51:36', '2021-07-12 13:51:36'),
(46748, 11056, 31450, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:20:50', '2021-08-11 13:20:50'),
(46749, 3040, 31450, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:24', '2021-08-20 14:28:24'),
(46750, 3040, 31450, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:36:01', '2021-08-30 09:36:01'),
(46751, 3040, 31450, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:37:01', '2021-08-30 09:37:01'),
(46752, 10057, 31450, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Any update on the following request?  Thanks & Regards,', NULL, NULL, '2021-10-14 11:33:07', '2021-10-14 11:33:07'),
(46753, 10057, 31450, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:25:46', '2021-11-11 17:25:46');
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
(46754, 10057, 31450, NULL, '2021-12-07 00:00:00.000', 'Approved', '	 Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:57:54', '2021-11-30 17:57:54'),
(46755, 3040, 31451, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46756, 1005, 31451, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:47:42', '2021-06-07 16:47:42'),
(46757, 3040, 31451, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:46:48', '2021-06-09 10:46:48'),
(46758, 3040, 31451, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:04', '2021-07-20 10:36:04'),
(46759, 11056, 31451, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:49:37', '2021-08-11 13:49:37'),
(46760, 3040, 31451, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:54', '2021-09-07 16:27:54'),
(46761, 10057, 31451, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:43:16', '2021-10-19 11:43:16'),
(46762, 10057, 31451, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:11:06', '2021-11-22 14:11:06'),
(46763, 10057, 31451, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:06:23', '2021-12-02 15:06:23'),
(46764, 10057, 31451, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:16:25', '2021-12-09 13:16:25'),
(46765, 10057, 31451, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:06:28', '2021-12-17 14:06:28'),
(46766, 10057, 31451, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:17:01', '2021-12-23 11:17:01'),
(46767, 10057, 31451, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:50:02', '2021-12-30 13:50:02'),
(46768, 20067, 31451, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:29:27', '2022-01-06 12:29:27'),
(46769, 20067, 31451, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:37:16', '2022-01-14 16:37:16'),
(46770, 20067, 31451, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 11/19/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:20:11', '2022-01-20 17:20:11'),
(46771, 3040, 31452, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46772, 1005, 31452, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:46:28', '2021-06-07 16:46:28'),
(46773, 11056, 31452, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Railroad Medicare PTAN has been assigned. Please allow three business days for the activation of this new PTAN. Please see the attachment Ref no : 21180001174', NULL, NULL, '2021-06-29 14:20:12', '2021-06-29 14:20:12'),
(46774, 3040, 31452, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MOLLY JOSEPH NP PROVIDER PTAN	Q00092288 PROVIDER NPI	1396380077 EFFECTIVE DATE	05/01/2021 END DATE	', NULL, NULL, '2021-07-12 09:13:20', '2021-07-12 09:13:20'),
(46775, 3040, 31453, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46776, 3040, 31453, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Florida only insurance. ', NULL, NULL, '2021-06-08 08:19:29', '2021-06-08 08:19:29'),
(46777, 3040, 31454, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:43', '2021-06-07 16:13:43'),
(46778, 3040, 31454, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: MOLLY JOSEPH  Tracking ID: T060720210004282  Reassignment Tracking ID: T060720210004394  Submitted Date: MON - JUNE 07 2021 06:18:22 PM EST  Submitted By: Molly joseph  Contact Email(s): NUCC@CLAIMSMEDINC.COM MOLLYJOSEPH60@YAHOO.COM', NULL, NULL, '2021-06-07 17:19:01', '2021-06-07 17:19:01'),
(46779, 3040, 31454, NULL, '2021-06-29 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: MOLLY JOSEPH Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1396380077 Individual Provider Transaction Access Number (PTAN): 1Q2511 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER PA Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: MAY 01, 2021', NULL, NULL, '2021-06-22 14:17:19', '2021-06-22 14:17:19'),
(46780, 3040, 31455, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46781, 3040, 31455, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:Dmarley@ghn-mci.com  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Galaxy Health ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:03:35', '2021-06-07 19:03:35'),
(46782, 3040, 31455, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-06-15 14:36:45', '2021-06-15 14:36:45'),
(46783, 3040, 31455, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:03:50', '2021-07-05 10:03:50'),
(46784, 3040, 31455, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:16', '2021-07-22 10:01:16'),
(46785, 11056, 31455, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:34:12', '2021-08-12 11:34:12'),
(46786, 10057, 31455, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:39:17', '2021-10-08 10:39:17'),
(46787, 10057, 31455, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:22:32', '2021-11-23 17:22:32'),
(46788, 10057, 31455, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:14:29', '2021-12-03 15:14:29'),
(46789, 10057, 31455, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:10:53', '2021-12-10 13:10:53'),
(46790, 10057, 31455, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:46:51', '2021-12-17 10:46:51'),
(46791, 10057, 31455, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:37:58', '2021-12-23 10:37:58'),
(46792, 19067, 31455, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:40:25', '2022-01-04 17:40:25'),
(46793, 20067, 31455, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:27:24', '2022-01-14 15:27:24'),
(46794, 20067, 31455, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:04:11', '2022-01-24 10:04:11'),
(46795, 20067, 31455, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:03:56', '2022-02-02 16:03:56'),
(46796, 20067, 31455, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:07:15', '2022-03-01 15:07:15'),
(46797, 20067, 31455, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:59:44', '2022-03-17 17:59:44'),
(46798, 22077, 31455, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:03:00', '2022-04-15 08:03:00'),
(46799, 22077, 31455, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:16:02', '2022-04-19 13:16:02'),
(46800, 22077, 31455, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:27:17', '2022-04-19 13:27:17'),
(46801, 3040, 31456, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46802, 3040, 31456, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:SWHPEXPEDITES@bswhealth.org  Subject:Enroll Providers || Longpoint Medical Center || Providers || Scott & White ||   Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:49:50', '2021-06-07 18:49:50'),
(46803, 3040, 31456, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Success! Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 8bdf2a63-e978-4741-81a8-f1070c4dfb2a  ', NULL, NULL, '2021-06-18 11:21:12', '2021-06-18 11:21:12'),
(46804, 3040, 31456, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:08', '2021-07-08 09:49:08'),
(46805, 3040, 31456, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:44', '2021-07-28 16:43:44'),
(46806, 11056, 31456, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:47:56', '2021-08-09 14:47:56'),
(46807, 3040, 31456, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:43:55', '2021-08-25 08:43:55'),
(46808, 3040, 31457, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46809, 3040, 31457, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Waiting for Medicaid', NULL, NULL, '2021-06-07 16:21:49', '2021-06-07 16:21:49'),
(46810, 3040, 31457, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to:  AM.Houston@superiorhealthplan.com  Subject: Enroll Provider || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Joseph, Molly || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health plan in our group under the below locations.   Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-15 08:37:03', '2021-07-15 08:37:03'),
(46811, 11056, 31457, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:26:14', '2021-08-13 16:26:14'),
(46812, 3040, 31457, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:26', '2021-08-27 16:43:26'),
(46813, 10057, 31457, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:24:23', '2021-10-11 15:24:23');
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
(46814, 10057, 31457, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Morning,  Hope you are doing well. Could you please provide me with the latest enrollment updates on the below mentioned provider with all locations as per mentioned TIN\'s.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1396380077  Please get to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-18 10:56:46', '2021-11-18 10:56:46'),
(46815, 10057, 31457, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hi,  At this time all requested information has been received for Molly Joseph (TIN: 270796429, NPI: 1396380077) and they are still being credentialed. Please reference ticket # 69130 if you have any questions.  Sincerely, Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson) ', NULL, NULL, '2021-11-19 10:08:46', '2021-11-19 10:08:46'),
(46816, 10057, 31457, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-01 10:00:29', '2021-12-01 10:00:29'),
(46817, 10057, 31457, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-08 09:33:38', '2021-12-08 09:33:38'),
(46818, 10057, 31457, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings!  Any update on the below request. This is my second reminder.  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-12-16 10:06:43', '2021-12-16 10:06:43'),
(46819, 10057, 31457, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  Your email was received. Your Account Manager will be contacting you to address your request. When contacting the Account Manager for updates on your issue, you can use this reference number #72511. If you need immediate assistance you can call to speak to an Account Manager by calling 1-800-656-4817 (English 1, Spanish 2) and option #3 for Provider Relations Team.  Thank you,  Teresa Rios Provider Account Manager', NULL, NULL, '2021-12-23 09:35:55', '2021-12-23 09:35:55'),
(46820, 10057, 31457, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Teresa,  Thank you for your response. 2 weeks have passed and no one reached out.to me with the update. Please do the needful.  Looking forward to hearing from you.  Regards,', NULL, NULL, '2021-12-30 11:03:38', '2021-12-30 11:03:38'),
(46821, 20067, 31457, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||   Good Morning,  Hope you are doing well. I want to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Molly Joseph	1396380077   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 10:01:22', '2022-01-06 10:01:22'),
(46822, 20067, 31457, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.     Timothy Do  Provider Account Manager II  Region 7 (Harris & Jefferson)', NULL, NULL, '2022-01-11 15:50:39', '2022-01-11 15:50:39'),
(46823, 20067, 31457, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received to: AM.Houston@superiorhealthplan.com  Sub: Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Afternoon,     Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #75028        If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team     Provider Services is available to help answer questions on claim payments, rejections, denials, to verify eligibility or for help escalating any issues you may have, M-F 8:00 a.m. CST – 6:00 p.m. CST. For claims related questions, be sure to have your claim number available.     Allwell  1-877-391-5921  Ambetter  1-877-687-1196  STAR, MRSA, CHIP, RSA, STAR+PLUS and STAR Kids  1-877-391-5921  STAR Health  1-866-439-2042                                            Adriano Garcia; CPhT  Provider Account Manager  Region 7 (Harris & Jefferson)', NULL, NULL, '2022-01-11 15:53:01', '2022-01-11 15:53:01'),
(46824, 20067, 31457, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good Afternoon!  Greetings,  No one has reached me till yet, kindly send me the welcome kit for Provider Joseph Molly.  Eagerly waiting for your response, Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 14:44:22', '2022-01-18 14:44:22'),
(46825, 20067, 31457, NULL, '2022-02-03 00:00:00.000', 'Approved', 'Received the following Email  Hello Syed,  The provider is effective 1/1/2022 and is listed with both of those address you provided below.', NULL, NULL, '2022-01-27 14:46:21', '2022-01-27 14:46:21'),
(46826, 3040, 31458, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46827, 3040, 31458, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || TRPN ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:46:55', '2021-06-07 18:46:55'),
(46828, 3040, 31458, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Provider Update Information Form- TRPN Inbo Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-24 13:41:04', '2021-06-24 13:41:04'),
(46829, 3040, 31458, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:35', '2021-07-05 15:25:35'),
(46830, 3040, 31458, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:23', '2021-07-20 08:32:23'),
(46831, 3040, 31459, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46832, 3040, 31459, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-06-07 18:31:41', '2021-06-07 18:31:41'),
(46833, 3040, 31460, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46834, 3040, 31460, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task', NULL, NULL, '2021-06-08 08:20:36', '2021-06-08 08:20:36'),
(46835, 3040, 31461, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46836, 3040, 31461, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Christus Spohn||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:06:30', '2021-06-07 19:06:30'),
(46837, 3040, 31461, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:03', '2021-06-18 11:50:03'),
(46838, 3040, 31461, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:24:21', '2021-07-06 14:24:21'),
(46839, 3040, 31461, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:30', '2021-07-27 16:53:30'),
(46840, 3040, 31461, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:20', '2021-07-28 11:20:20'),
(46841, 3040, 31462, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46842, 1005, 31462, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-06-07 16:40:02', '2021-06-07 16:40:02'),
(46843, 3040, 31462, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-15 09:36:25', '2021-06-15 09:36:25'),
(46844, 3040, 31462, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:26', '2021-07-22 10:04:26'),
(46845, 11056, 31462, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:52:51', '2021-08-09 08:52:51'),
(46846, 3040, 31462, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:46', '2021-08-17 09:55:46'),
(46847, 10057, 31462, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned groups as we have submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails and let me know the current status of our application.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Please feel free to contact or email me if you have any questions or concerns.  Thanks & Regards,', NULL, NULL, '2021-10-06 15:31:39', '2021-10-06 15:31:39'),
(46848, 10057, 31462, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned 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	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:18:09', '2021-10-14 11:18:09'),
(46849, 10057, 31462, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 15:05:54', '2021-11-18 15:05:54'),
(46850, 10057, 31462, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:51:53', '2021-12-01 11:51:53'),
(46851, 10057, 31462, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:29:40', '2021-12-08 10:29:40'),
(46852, 10057, 31462, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:05:10', '2021-12-16 11:05:10'),
(46853, 10057, 31462, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:13:02', '2021-12-22 10:13:02'),
(46854, 10057, 31462, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:21:52', '2021-12-29 11:21:52'),
(46855, 19067, 31462, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:22:02', '2022-01-05 11:22:02'),
(46856, 19067, 31462, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:33:53', '2022-01-06 16:33:53'),
(46857, 20067, 31462, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:05:58', '2022-01-14 14:05:58'),
(46858, 20067, 31462, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:36:52', '2022-01-14 14:36:52'),
(46859, 3040, 31463, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46860, 3040, 31463, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task', NULL, NULL, '2021-06-08 08:20:26', '2021-06-08 08:20:26'),
(46861, 3040, 31464, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46862, 3040, 31464, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:vipproviders@anci-care.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:09:28', '2021-06-07 19:09:28'),
(46863, 3040, 31464, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: pdavidson@anci-care.com  Subject: RE: Enroll Providers || Longpoint Medical Center || Providers || Anci Care ||  Hi.  We have this facility contracted under Normandy Urgent Care Center.  This provider is included as long as they bill under the same Tax ID number and facility address.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121', NULL, NULL, '2021-06-24 14:58:01', '2021-06-24 14:58:01'),
(46864, 3040, 31464, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: pdavidson@anci-care.com  Subject:  RE: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Jennifer,  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Hi.  Would you please get the information to load this facility under Normandy Urgent Care? Parent Provider ID #437362  Thanks,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-06-24 15:13:35', '2021-06-24 15:13:35'),
(46865, 3040, 31464, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email rcvd from: jmaligaya@anci-care.com  Subject: RE: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Anci Care||  Hello,  I have sent the information to our data management team.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-06-24 15:14:21', '2021-06-24 15:14:21'),
(46866, 3040, 31464, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:14', '2021-07-13 11:36:14'),
(46867, 3040, 31465, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46868, 3040, 31465, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:ccnprovider@triwest.com   Subject:Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Triwest ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 19:16:00', '2021-06-07 19:16:00'),
(46869, 3040, 31465, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:13:47', '2021-06-18 10:13:47'),
(46870, 3040, 31465, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:00', '2021-07-20 11:05:00'),
(46871, 3040, 31465, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:34', '2021-07-22 14:31:34'),
(46872, 3040, 31466, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46873, 1005, 31466, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Doesnt cover this area.', NULL, NULL, '2021-06-07 17:47:27', '2021-06-07 17:47:27'),
(46874, 3040, 31468, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46875, 3040, 31468, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task', NULL, NULL, '2021-06-08 08:21:30', '2021-06-08 08:21:30'),
(46876, 3040, 31468, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task not cover under NUCC.', NULL, NULL, '2021-06-08 08:21:48', '2021-06-08 08:21:48'),
(46877, 3040, 31475, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:44', '2021-06-07 16:13:44'),
(46878, 3040, 31475, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Redundant task', NULL, NULL, '2021-06-08 08:19:58', '2021-06-08 08:19:58'),
(46879, 3040, 31480, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:45', '2021-06-07 16:13:45'),
(46880, 3040, 31480, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:providerservices@renaissancefamily.com   Subject: Enroll Providers ||Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers || Renaissance Physicians ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:53:10', '2021-06-07 18:53:10'),
(46881, 3040, 31480, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:40:02', '2021-06-17 14:40:02'),
(46882, 3040, 31480, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:24', '2021-07-05 16:48:24'),
(46883, 3040, 31480, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:33', '2021-07-26 12:43:33'),
(46884, 11056, 31480, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:22:35', '2021-08-11 16:22:35');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(46885, 3040, 31480, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:44', '2021-08-18 13:11:44'),
(46886, 3040, 31481, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:45', '2021-06-07 16:13:45'),
(46887, 1005, 31481, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:31', '2021-06-07 16:54:31'),
(46888, 10057, 31481, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:37:11', '2021-12-30 15:37:11'),
(46889, 19067, 31481, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:27:14', '2022-01-05 17:27:14'),
(46890, 20067, 31481, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:16:00', '2022-01-18 09:16:00'),
(46891, 20067, 31481, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:07', '2022-01-28 09:16:07'),
(46892, 20067, 31481, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:44', '2022-02-09 15:29:44'),
(46893, 20067, 31481, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:12', '2022-02-21 09:29:12'),
(46894, 20067, 31481, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:20', '2022-03-01 14:08:20'),
(46895, 20067, 31481, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:10:51', '2022-03-01 14:10:51'),
(46896, 20067, 31481, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:31', '2022-03-18 10:47:31'),
(46897, 19067, 31481, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 09/15/2021. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 15:01:31', '2022-03-30 15:01:31'),
(46898, 3040, 31482, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:13:45', '2021-06-07 16:13:45'),
(46899, 1005, 31482, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  --  -- Regards,Benjamin Cooper | Claims Med | Office: (713) 429-4169 Ext: 403 | Fax: 718-640-2713 | kh@claimsmedinc.comCONFIDENTIALITY NOTICE: This e-mail andany files transmitted with it are the property of Claims Med or its affiliates,are confidential, and are intended solely for the use of the individual orentity to whom this e-mail is addressed. If you are not one of the namedrecipients or otherwise have reason to believe that you have received thise-mail in error, please notify the sender and delete this message immediatelyfrom your computer. Any other use, retention, dissemination, forwarding,printing or copying of this e-mail is strictly prohibited. ', NULL, NULL, '2021-06-07 17:45:34', '2021-06-07 17:45:34'),
(46900, 3040, 31482, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Re: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,  Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E, Houston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-22 14:14:06', '2021-06-22 14:14:06'),
(46901, 11056, 31482, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 12:54:25', '2021-06-29 12:54:25'),
(46902, 3040, 31482, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:22', '2021-07-19 09:23:22'),
(46903, 3040, 31482, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:07', '2021-07-28 11:39:07'),
(46904, 11056, 31482, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:03:15', '2021-08-11 17:03:15'),
(46905, 3040, 31482, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:40', '2021-08-17 15:02:40'),
(46906, 3040, 31482, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:39', '2021-09-14 16:14:39'),
(46907, 12062, 31482, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:04:27', '2021-09-22 13:04:27'),
(46908, 10057, 31482, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:28:39', '2021-10-18 16:28:39'),
(46909, 10057, 31482, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can someone please get back to me with an update on our applications for providers, I have attached our group roster, also if there should be any concerned person who will help me out with my queries rather than sending everyone an email for an update, and also our applications are stuck now for way too much time.  If they are completed please provide me with the effective dates and Copy of there Welcome Letters / Contract.  Regards, Alex', NULL, NULL, '2021-11-10 17:41:02', '2021-11-10 17:41:02'),
(46910, 10057, 31482, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good afternoon,  All 3 facilities are awaiting the November Credentials Committee Meeting that is scheduled for November 16, 2021. If you have not received Welcome Letters by December 1st, then please send another email to CHRISTUS.HP.Credentialing@christushealth.org requesting the letters. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254', NULL, NULL, '2021-11-10 17:44:27', '2021-11-10 17:44:27'),
(46911, 10057, 31482, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:38:18', '2021-11-18 13:38:18'),
(46912, 10057, 31482, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:41:20', '2021-12-01 10:41:20'),
(46913, 10057, 31482, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:49:42', '2021-12-14 09:49:42'),
(46914, 10057, 31482, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:34:24', '2021-12-20 13:34:24'),
(46915, 10057, 31482, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:36:28', '2021-12-20 13:36:28'),
(46916, 10057, 31482, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:54:11', '2021-12-28 11:54:11'),
(46917, 19067, 31482, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:24:00', '2022-01-04 17:24:00'),
(46918, 19067, 31482, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:05', '2022-01-05 11:33:05'),
(46919, 20067, 31482, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:24:13', '2022-01-14 13:24:13'),
(46920, 20067, 31482, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:25', '2022-01-21 16:45:25'),
(46921, 20067, 31482, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:06:07', '2022-01-25 17:06:07'),
(46922, 3040, 31483, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46923, 3040, 31483, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'CAQH is pending because of Mal practice and informed client and waiting for the response.', NULL, NULL, '2021-06-08 08:15:27', '2021-06-08 08:15:27'),
(46924, 3040, 31483, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 312407', NULL, NULL, '2021-06-14 16:56:09', '2021-06-14 16:56:09'),
(46925, 11056, 31483, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : ProfessionalProviderNetworkDept@bcbstx.com  Sub : Enrollment Status Query - CUCC - Blue Cross Blue Shield  Good morning,  Hope you are doing well. I want to know the enrollment status of the following provider.  Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider  Provider Name: Joseph, Molly Provider NPI# : 1396380077  If you have any questions feel free to contact me. Respond me as soon as possible.  Thank you!', NULL, NULL, '2021-07-01 09:36:57', '2021-07-01 09:36:57'),
(46926, 3040, 31483, NULL, '2021-07-21 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : COLUMBUS URGENT CARE PA Group Record Id : H000J5J401  Provider Name : MOLLY JOSEPH Provider Record Number : H08PR93101 Specialty : ANP/CERT/CLNP', NULL, NULL, '2021-07-14 14:16:57', '2021-07-14 14:16:57'),
(46927, 3040, 31484, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46928, 3040, 31484, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-06-07 18:08:13', '2021-06-07 18:08:13'),
(46929, 3040, 31485, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46930, 3040, 31485, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Waiting for CAQH completion ', NULL, NULL, '2021-06-07 18:28:03', '2021-06-07 18:28:03'),
(46931, 3040, 31485, NULL, '2021-06-21 00:00:00.000', 'In Process', 'I had a word with (Joe C) Cigna representative and he submitted the application online.  Application no: 12643004 Ref: Joe C 06/14/2021 ', NULL, NULL, '2021-06-14 17:10:51', '2021-06-14 17:10:51'),
(46932, 11056, 31485, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : PSSCentral@cigna.com  Sub : Enrollment Status Query - Columbus Urgent Care PA - Cigna   Greetings,  Hope you are doing well. I want to ask about the enrollment status of the following provider under the following practice. The application has been submitted online on 06/14/2021. Application no. : 12643004  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider  Provider Name: Joseph, Molly Provider NPI# : 1396380077  Kindly respond as soon as possible. Feel free to reach out for any further information.  Thank you!', NULL, NULL, '2021-07-01 10:59:42', '2021-07-01 10:59:42'),
(46933, 3040, 31485, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had a word with (Paul) Cigna representative and he said the provider is out of network and application is still in the process.  ', NULL, NULL, '2021-07-22 10:49:15', '2021-07-22 10:49:15'),
(46934, 11056, 31485, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	psscentral@cigna.com  Sub : Enrollment Status Query - Columbus Urgent Care PA - Cigna  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following provider under the following practice. The application has been submitted online on 06/14/2021. Application no. : 12643004  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Provider Name: Joseph, Molly Provider NPI# : 1396380077  Kindly respond as soon as possible. Feel free to reach out for any further information.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 15:15:34', '2021-08-04 15:15:34'),
(46935, 12062, 31485, NULL, '2021-09-21 00:00:00.000', 'Approved', 'As per the tele conversation with Cigna rep Robert S . the provider has been enrolled in network with Cigna with plans: open access plus, ppo & hmo. The effective date is August 12,2021. the reference to this call was rep name and todays date. see attached screenshots for a reference  ', NULL, NULL, '2021-09-13 16:30:38', '2021-09-13 16:30:38'),
(46936, 3040, 31486, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46937, 3040, 31486, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to:networkhelp@uhc.com  Subject: Enroll Providers || Columbus Urgent Care PA || Providers || UHC ||  Greetings,   I wanted to know how to enroll the below providers mentioned.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-07 18:17:47', '2021-06-07 18:17:47'),
(46938, 3040, 31486, NULL, '2021-07-01 00:00:00.000', 'On Hold', 'Pending group enrollment.  ', NULL, NULL, '2021-06-24 11:03:22', '2021-06-24 11:03:22'),
(46939, 3040, 31487, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46940, 1005, 31487, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:55:26', '2021-06-07 16:55:26'),
(46941, 3040, 31487, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Rejection letter received, attached for reference: Dear Provider: Thank you for your interest in becoming a participating provider in the Texas Children’s Health Plan network. We regret to inform you that we will not be able to offer you an Agreement at this time. We are not licensed to contract in Colorado County for the STAR, STAR Kids or CHIP Programs. We will keep your letter of interest on file should our service area change in the future.  Thank you again for your interest.  Sincerely, Contracts Administration Texas Children’s Health Plan', NULL, NULL, '2021-07-20 09:40:18', '2021-07-20 09:40:18'),
(46942, 3040, 31488, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46943, 3040, 31488, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Email rcvd from: MDuffee@humana.com  Subject: Need Enroll || Fernandus, Limy || Columbus Urgent Care PA || Humana  The providers are under a group contract. We do not add physicians or midlevel\'s to ancillary agreements.', NULL, NULL, '2021-06-07 18:24:50', '2021-06-07 18:24:50'),
(46944, 3040, 31489, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46945, 1005, 31489, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:37', '2021-06-07 16:49:37'),
(46946, 3040, 31489, NULL, '2021-07-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-07-20 09:41:16', '2021-07-20 09:41:16'),
(46947, 3040, 31490, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46948, 1005, 31490, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:50:09', '2021-06-07 16:50:09'),
(46949, 3040, 31490, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @   https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/', NULL, NULL, '2021-07-20 09:39:14', '2021-07-20 09:39:14'),
(46950, 3040, 31491, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:18', '2021-06-07 16:17:18'),
(46951, 1005, 31491, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:51:41', '2021-06-07 16:51:41'),
(46952, 11056, 31491, NULL, '2021-07-01 00:00:00.000', 'In Process', 'The enrollment form has been submitted for enrollment. Waiting for the contract. Please see the attachments.', NULL, NULL, '2021-06-23 14:41:43', '2021-06-23 14:41:43'),
(46953, 3040, 31491, NULL, '2021-07-20 00:00:00.000', 'In Process', 'I had a word with (Earl A) and he advised that the application rcvd yesterday and will take 60 business days.   Ref: 6030025308', NULL, NULL, '2021-07-13 08:49:32', '2021-07-13 08:49:32'),
(46954, 3040, 31491, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you! ', NULL, NULL, '2021-07-19 11:31:29', '2021-07-19 11:31:29'),
(46955, 11056, 31491, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good morning!  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details:  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-04 16:20:36', '2021-08-04 16:20:36'),
(46956, 3040, 31491, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: AlagarSamyN@aetna.com  Subject; Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello Nandhini,  Hope you are doing well. Kindly advise the procedure to link the providers under the below Tax ID. As you mentioned in your previous email that most of the providers are not linked to the Tax ID.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI#  1033623616  Provider 2:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Kourouma , Odette Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 10:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 11:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 16:   Provider Name: Jose, Julie Provider NPI# 1447883061  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-08-30 12:01:20', '2021-08-30 12:01:20'),
(46957, 10057, 31491, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practice Columbus Urgent Care PA in First Health.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Your earlier response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:59:23', '2021-10-11 16:59:23'),
(46958, 10057, 31491, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Received From : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani', NULL, NULL, '2021-10-18 10:31:28', '2021-10-18 10:31:28'),
(46959, 10057, 31491, NULL, '2021-11-24 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Hope you are doing well. Could you please let me know the updated status on our enrollment request for the mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 17:08:25', '2021-11-17 17:08:25'),
(46960, 10057, 31491, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Received From : MadirajuP@aetna.com  Sub: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hi,  Please find the status of the list of Provider’s status attached.  Thank You, Phani', NULL, NULL, '2021-11-22 17:34:28', '2021-11-22 17:34:28'),
(46961, 10057, 31491, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-22 17:40:31', '2021-11-22 17:40:31'),
(46962, 10057, 31491, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Kindly revert back to me as soon as possible!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:36:13', '2021-12-02 13:36:13'),
(46963, 10057, 31491, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Hello,  Can I get an update on the below mentioned providers enrollment request. It is my second reminder.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:04:28', '2021-12-09 11:04:28'),
(46964, 10057, 31491, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good afternoon,  Any update on the below request? Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 14:32:41', '2021-12-16 14:32:41'),
(46965, 10057, 31491, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : AlagarSamyN@aetna.com & MadirajuP@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request.  Looking forward to your early response.  Regards,', NULL, NULL, '2021-12-22 10:53:25', '2021-12-22 10:53:25'),
(46966, 10057, 31491, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com & AlagarSamyN@aetna.com  Sub : Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Still waiting to get an update from your side, the process is getting late day by day. Please let me know the status?  Regards,', NULL, NULL, '2021-12-29 15:51:41', '2021-12-29 15:51:41');
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
(46967, 19067, 31491, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com & AlagarSamyN@aetna.com  Subject: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers.   Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1073019493 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:33:13', '2022-01-04 13:33:13'),
(46968, 20067, 31491, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Morning! Hope you are doing great. Any update on the below-mentioned request?  Kindly respond promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:19:08', '2022-01-19 12:19:08'),
(46969, 20067, 31491, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com, AlagarSamyN@aetna.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group & Providers || First Health ||  Good Afternoon!  Kindly respond promptly or provide me with the email address where I can send the queries.  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 12:29:50', '2022-01-27 12:29:50'),
(46970, 20067, 31491, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Application submitted online. Allow 45-60 Days to process the request. See the attachment ', NULL, NULL, '2022-02-02 10:17:43', '2022-02-02 10:17:43'),
(46971, 20067, 31491, NULL, '2022-02-24 00:00:00.000', 'In Process', 'There is no follow ups,  Allow 90 days to process the request.', NULL, NULL, '2022-02-17 17:10:29', '2022-02-17 17:10:29'),
(46972, 20067, 31491, NULL, '2022-03-08 00:00:00.000', 'On Hold', 'Called Aetna and Spoke to Jesseca  Ref# 6077272236  Panel is currently closed for contacting since 01/12/2022 Call us back after 30 business days to check if the panel is open.', NULL, NULL, '2022-03-01 10:49:19', '2022-03-01 10:49:19'),
(46973, 3040, 31492, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46974, 3040, 31492, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject:Enroll Providers || Columbus Urgent Care PA || Providers || Health Smart ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:26:18', '2021-06-07 18:26:18'),
(46975, 11056, 31492, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Enrollment form has been submitted. Please see the attachment. Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. ', NULL, NULL, '2021-06-23 15:05:46', '2021-06-23 15:05:46'),
(46976, 11056, 31492, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Providers: Provider 1:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-01 09:15:12', '2021-07-01 09:15:12'),
(46977, 11056, 31492, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  01- Following Providers are currently in the credentialing process.  Provider Name   Stephen, Ani   PICCIONE JR, JAMES M   Chennemkara, Mini Philip   Abraham, Glory   Abraham, Jeena   Paul, Sigi   Jacob, Jaya   Please review the attached Application Review Form and forward the missing information within the next 5 days.  Alternatively, please update CAQH and advise once completed.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-05 08:54:31', '2021-07-05 08:54:31'),
(46978, 11056, 31492, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  02- We are returning your application due to missing information listed below.  Provider Name   Missing Information   Joseph, Molly NP   The application form does not have the tin \" 47-1914151 \" on it.  Please update the CAQH to include the missing tax id.  ', NULL, NULL, '2021-07-05 08:56:09', '2021-07-05 08:56:09'),
(46979, 11056, 31492, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to : 	pr.south@healthsmart.com  Sub : Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Good morning!  CAQH has been updated please check it.  If you have further questions or issues please let me know.  Thank you!', NULL, NULL, '2021-07-05 08:57:14', '2021-07-05 08:57:14'),
(46980, 3040, 31492, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Health Smart in our group under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1:  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-23 13:43:36', '2021-07-23 13:43:36'),
(46981, 3040, 31492, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query- Columbus Urgent Care PA - Health Smart  Hi,  Please see the following Providers with effective dates.  Provider Name                                 Effective Date   STEPHEN, ANI                                      06/01/2021   CHENNEMKARA, MINI P                     06/01/2021   PICCIONE JR, JAMES M                        06/01/2021   ABRAHAM, GLORY                               06/01/2021   ABRAHAM, JEENA                                 06/01/2021   Joseph Molly, NP                                   09/01/2021   All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com   (Inventory Log ID : 81523)  Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-07-28 09:11:30', '2021-07-28 09:11:30'),
(46982, 3040, 31493, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46983, 3040, 31493, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com   Subject:Enroll Providers || Columbus Urgent Care PA || Providers || Multiplan ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you  ', NULL, NULL, '2021-06-08 08:16:50', '2021-06-08 08:16:50'),
(46984, 3040, 31493, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Service Case Number:	7652781 Details have been emailed to you at: cucc@claimsmedinc.com', NULL, NULL, '2021-06-25 14:16:37', '2021-06-25 14:16:37'),
(46985, 3040, 31493, NULL, '2021-07-22 00:00:00.000', 'Approved', 'I had a word with Shanda Multiplan representative and she advised the provider is participating with Multiplan.   Ref: 7612502', NULL, NULL, '2021-07-15 09:33:50', '2021-07-15 09:33:50'),
(46986, 3040, 31494, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46987, 1005, 31494, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:04', '2021-06-07 16:45:04'),
(46988, 11056, 31494, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual provider. See group task. ', NULL, NULL, '2021-06-23 16:08:18', '2021-06-23 16:08:18'),
(46989, 11056, 31494, NULL, '2021-07-01 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-06-23 16:08:55', '2021-06-23 16:08:55'),
(46990, 3040, 31495, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46991, 1005, 31495, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:45:37', '2021-06-07 16:45:37'),
(46992, 1005, 31495, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Portal Ticket #	  17882353 Application Name: Molly-CUCC Status Update Date: 06/29/2021 Status: Submitted.', NULL, NULL, '2021-06-29 11:48:27', '2021-06-29 11:48:27'),
(46993, 3040, 31495, NULL, '2021-07-26 00:00:00.000', 'Approved', 'Provider is participating with Medicaid with the effective date 05/01/2021.  ', NULL, NULL, '2021-07-19 09:37:13', '2021-07-19 09:37:13'),
(46994, 3040, 31496, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46995, 1005, 31496, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Memorial Hermann enrollment is covered under Aetna plans, pending Aetna enrollment. ', NULL, NULL, '2021-06-07 16:52:54', '2021-06-07 16:52:54'),
(46996, 3040, 31496, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:26', '2021-06-08 14:28:26'),
(46997, 3040, 31498, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(46998, 1005, 31498, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:53:57', '2021-06-07 16:53:57'),
(46999, 3040, 31498, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add the individual providers.   Contract attached in group task. ', NULL, NULL, '2021-07-20 10:29:07', '2021-07-20 10:29:07'),
(47000, 3040, 31499, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47001, 1005, 31499, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-06-07 16:54:56', '2021-06-07 16:54:56'),
(47002, 3040, 31499, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enroll Provider || Columbus Urgent Care PA || Joseph, Molly || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:37:55', '2021-07-20 09:37:55'),
(47003, 11056, 31499, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to :  AM.Austin@superiorhealthplan.com  &  Credentialing  credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Joseph, Molly|| Superior Health ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health in our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Superior Health plan twice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:35:50', '2021-08-05 11:35:50'),
(47004, 3040, 31499, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to; AM.Houston@superiorhealthplan.com  Subject: Re: Enroll Provider || Columbus Urgent Care PA || Joseph, Molly || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Superior Health in our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks ', NULL, NULL, '2021-08-27 11:14:42', '2021-08-27 11:14:42'),
(47005, 10057, 31499, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Afternoon,  Hope this email finds you well. I want to get the latest updates on my credentialing application of the below mentioned providers under the facility Columbus Urgent Care PA.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:25:09', '2021-10-19 11:25:09'),
(47006, 10057, 31499, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email Received From : credentialing@superiorhealthplan.com  Sub: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831  Credentialing@superiorhealthplan.com', NULL, NULL, '2021-10-20 08:55:41', '2021-10-20 08:55:41'),
(47007, 10057, 31499, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Dear Concern, Can you please send me the copy of the Welcome Packets and effective dates for the following providers, at your earliest convenience as we have tried to get those from you guys but didn\'t get any proper response on those.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Joseph, Molly	1396380077 Stephen, Ani	1588959118 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956  Please get back to me asap.  Regards,', NULL, NULL, '2021-10-28 08:21:07', '2021-10-28 08:21:07'),
(47008, 10057, 31499, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com & credentialing@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Good Morning,  Hope this email finds you well. Can I get the latest updates on the below highlighted provider enrollment request under the group TIN.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Joseph, Molly	1396380077  Looking forward to your early response.  Thanks & Regards,', NULL, NULL, '2021-11-18 09:27:24', '2021-11-18 09:27:24'),
(47009, 10057, 31499, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Good morning,  Provider 1396380077- is in credentialing process no effective date at this time.  Thanks,  YA Account Management  Region 3', NULL, NULL, '2021-12-01 13:49:15', '2021-12-01 13:49:15'),
(47010, 10057, 31499, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Need Copy of Welcome Packet  Thank you for providing the updated information.   Regards,', NULL, NULL, '2021-12-08 11:07:49', '2021-12-08 11:07:49'),
(47011, 10057, 31499, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-14 13:28:22', '2021-12-14 13:28:22'),
(47012, 10057, 31499, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider 1396380077- is currently in make par status with an effective date of 1/1/21.  Thanks Account Management', NULL, NULL, '2021-12-21 13:20:25', '2021-12-21 13:20:25'),
(47013, 10057, 31499, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Thank you for providing me with the update. When can I get the welcome packet?  Regards,', NULL, NULL, '2021-12-28 15:15:30', '2021-12-28 15:15:30'),
(47014, 19067, 31499, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with Superior Health.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Provider Name	NPI	Location Molly Joseph	1396380077	926 Walnut St, Columbus, TX 78934-2215   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:17:42', '2022-01-04 13:17:42'),
(47015, 19067, 31499, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||     Good afternoon,     Provider 1396380077 is effective 1/1/22.        Thanks,     YA  Account Management  Region 3', NULL, NULL, '2022-01-05 17:59:10', '2022-01-05 17:59:10'),
(47016, 19067, 31499, NULL, '2022-01-20 00:00:00.000', 'Approved', 'See Attachment for Superior\'s Directory.', NULL, NULL, '2022-01-13 15:04:32', '2022-01-13 15:04:32'),
(47017, 3040, 31500, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47018, 3040, 31500, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Providers || Columbus Urgent Care PA || Providers || Tricare||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:20:43', '2021-06-07 18:20:43'),
(47019, 3040, 31500, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Provider certification application from sent it through fax. ', NULL, NULL, '2021-06-24 13:20:46', '2021-06-24 13:20:46'),
(47020, 3040, 31500, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to:  KMoten4@humana.com  Subject: Enrollment Status || Columbus Urgent Care PA || Joseph, Molly || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Columbus Urgent Care PA under the below location. We already sent the certification application form through fax on 06/24/2021.   Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-13 11:58:37', '2021-07-13 11:58:37'),
(47021, 11056, 31500, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hey Katherine!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group under the below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  Have a great day!', NULL, NULL, '2021-08-05 13:10:17', '2021-08-05 13:10:17'),
(47022, 3040, 31500, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Joseph, Molly || Tricare ||  Hello Katherine,  Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Tricare in our group under the below location.   Practice Details: Group Name: Columbus Urgent Care PA Group NPI# 1215330501 Group TIN# 47-1914151 Group Address: 926 Walnut St, Columbus TX, 78934  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-18 15:41:39', '2021-08-18 15:41:39'),
(47023, 10057, 31500, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : KMoten4@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hello Katherine,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned providers in Tricare in our group Columbus Urgent Care under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Joseph, Vibitha	1952931560 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 John, Jeny	1073019493 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Molly	1073019493  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:08:44', '2021-10-11 15:08:44'),
(47024, 10057, 31500, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : KMoten4@humana.com & ywyatt@humana.com & HGBProviderRosters@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Morning,  Any update on below credentialing request.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-10-15 08:30:09', '2021-10-15 08:30:09'),
(47025, 10057, 31500, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Hello Steve,  The updates emailed to HGB Roster team can take up to 60 days to process. There is not changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:33:31', '2021-11-11 17:33:31'),
(47026, 10057, 31500, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:53:36', '2021-12-02 09:53:36'),
(47027, 10057, 31500, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Greetings!  Any update on the below request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-15 13:23:06', '2021-12-15 13:23:06'),
(47028, 10057, 31500, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Morning Steve,  We show Jeny John 1073019493 has not been added to this tax id. There are two ways to add  a Provider and it is via the secured Provider Portal are you can send a spreadsheet to the HGB Roster team to add a Provider. I have attached a copy of the instruction on how to add a provider via the Secured Provider Portal.  Molly Joseph 1396380077 is added to the Columbus Texas location. You can check status by creating a log in on the Provider Portal.  The link is highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-21 13:28:06', '2021-12-21 13:28:06'),
(47029, 10057, 31500, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - CUCC - Tricare  Thank you for sharing this information and update with me.  Kind Regards,', NULL, NULL, '2021-12-29 16:24:58', '2021-12-29 16:24:58'),
(47030, 19067, 31500, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Query || CUCC || Jeny John & Molly Joseph || Tricare ||  Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers with Tricare.  Group Name	Columbus Urgent Care PA Tax ID	47-1914151 Group NPI	1215330501 Provider Name	NPI	Location Jeny John	1073019493	926 Walnut St, Columbus, TX 78934-2215 Molly Joseph	1396380077	926 Walnut St, Columbus, TX 78934-2215   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:11:46', '2022-01-04 13:11:46'),
(47031, 19067, 31500, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: Enrollment Query || CUCC || Jeny John & Molly Joseph || Tricare ||     Good Morning Hammad,     We show these providers has been added to this group tax id. You can check status on a provider by creating a log in on the Provider Portal or check the network Directory.     HumanaMilitary - Find care (goperspecta.com)', NULL, NULL, '2022-01-10 10:08:24', '2022-01-10 10:08:24'),
(47032, 20067, 31500, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Called Tricare and spoke to Ashley   Effective date:12/06/2021 ID: 471914151-78934-A020 Expiration Date: 09/30/2022 Ref# 14977281  ', NULL, NULL, '2022-01-21 13:05:52', '2022-01-21 13:05:52'),
(47033, 3040, 31501, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47034, 1005, 31501, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:47:38', '2021-06-07 16:47:38'),
(47035, 3040, 31501, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:54:20', '2021-06-09 10:54:20'),
(47036, 3040, 31501, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:32', '2021-07-20 09:44:32'),
(47037, 11056, 31501, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:40:41', '2021-08-05 13:40:41'),
(47038, 3040, 31501, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:31', '2021-09-03 14:38:31'),
(47039, 10057, 31501, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:19', '2021-10-18 11:41:19'),
(47040, 10057, 31501, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:13', '2021-11-23 17:38:13'),
(47041, 10057, 31501, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Request Submit  Please see attachment:', NULL, NULL, '2021-12-03 17:53:58', '2021-12-03 17:53:58'),
(47042, 10057, 31501, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-10 15:08:47', '2021-12-10 15:08:47'),
(47043, 10057, 31501, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:03:55', '2021-12-13 13:03:55'),
(47044, 10057, 31501, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:23', '2021-12-20 13:29:23'),
(47045, 10057, 31501, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:46:56', '2021-12-27 12:46:56'),
(47046, 10057, 31501, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:09', '2021-12-30 14:08:09'),
(47047, 19067, 31501, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:40:11', '2022-01-10 09:40:11'),
(47048, 20067, 31501, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:26', '2022-01-19 12:27:26'),
(47049, 20067, 31501, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 11/21/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:17:08', '2022-01-19 17:17:08'),
(47050, 3040, 31502, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47051, 1005, 31502, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-06-07 16:46:24', '2021-06-07 16:46:24'),
(47052, 3040, 31502, NULL, '2021-07-27 00:00:00.000', 'In Process', 'PROVIDER NAME	MOLLY JOSEPH NP PROVIDER PTAN	Q00101820 PROVIDER NPI	1396380077 EFFECTIVE DATE	05/01/2021  Reference Number :	21180001158', NULL, NULL, '2021-07-20 09:27:13', '2021-07-20 09:27:13'),
(47053, 3040, 31502, NULL, '2021-08-03 00:00:00.000', 'Approved', 'Provider is participating with Medicare Railroad. Please see attachment.', NULL, NULL, '2021-07-27 11:14:50', '2021-07-27 11:14:50'),
(47054, 3040, 31503, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47055, 3040, 31503, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'We adding the provider in NUCC, LPMC & IVUC. Waiting for the approval. Once we get the approval we can reassign the provider under CUCC. ', NULL, NULL, '2021-06-07 17:25:47', '2021-06-07 17:25:47'),
(47056, 3040, 31503, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Enrollment Tracking Information Applicant Name: MOLLY JOSEPH  Tracking ID: T062220210004265  Reassignment Tracking ID: T062220210004266  Submitted Date: TUE - JUNE 22 2021 04:48:31 PM EST  Submitted By: Molly joseph  Contact Email(s): NUCC@CLAIMSMEDINC.COM MOLLYJOSEPH60@YAHOO.COM', NULL, NULL, '2021-06-22 15:49:13', '2021-06-22 15:49:13'),
(47057, 3040, 31503, NULL, '2021-07-06 00:00:00.000', 'Approved', 'Medicare Enrollment Information Individual Name: MOLLY JOSEPH Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1396380077 Individual Provider Transaction Access Number (PTAN): 1Q8323 Group Legal Business Name (LBN): COLUMBUS URGENT CARE PA Group NPI: 1215330501 Group PTAN: 399951 Reassignment Effective Date: MAY 01, 2021 Changed Information: N/A', NULL, NULL, '2021-06-29 08:59:48', '2021-06-29 08:59:48'),
(47058, 3040, 31504, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47059, 3040, 31504, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject:Enroll Providers || Columbus Urgent Care PA || Providers || Galaxy Health ||  Greetings,   I wanted to know how to enroll the below mentioned provider.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-221  Provider Name: Joseph, Molly Provider NPI# 1396380077  Thank you ', NULL, NULL, '2021-06-07 18:27:28', '2021-06-07 18:27:28'),
(47060, 3040, 31504, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Enroll Providers || Columbus Urgent Care PA || Providers || Galaxy Health ||  Hello Chris,   Hope you are doing well. Please find the attached Provider enrollment form along with the documents that you requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-08 12:57:32', '2021-06-08 12:57:32'),
(47061, 3040, 31504, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Subject: Galaxy Provider Application  Hello Chris,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 09:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 10:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 13:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 14:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-25 09:40:34', '2021-06-25 09:40:34'),
(47062, 3040, 31504, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email rcvd from: cguerue@ghn-mci.com  Subject: RE: Galaxy Provider Application  Good Morning,  I found that all providers are linked to the group agreement effective 1/1/21.  Karen Avalos, kavalos@ghn-mci.com is the contact for TX groups, should you have any additional questions please direct them to her, however, I do the new provider enrollments should you have any providers to add in future.', NULL, NULL, '2021-07-14 11:07:44', '2021-07-14 11:07:44'),
(47063, 3040, 31504, NULL, '2021-07-21 00:00:00.000', 'Approved', 'I had a word with Karen Galaxy Health representative and she advised the provider is in-network with the effective date 01/01/2021.   Ref: Karen 07/14/2021', NULL, NULL, '2021-07-14 13:09:38', '2021-07-14 13:09:38'),
(47064, 3040, 31505, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47065, 3040, 31505, NULL, '2021-06-14 00:00:00.000', 'Approved', 'From: Richard.Hinkley@bswhealth.org  Good afternoon Martin,  As previously stated the individual providers are no longer credentialed only the facility. The Facility Credentialing has been completed and I submitted SR and SAM tickets to have them setup with configuration before I went on vacation. I believe you got a few different automatic replies from me so sorry for the delay. Those tickets are still in process but I will submit a copy of the contract which goes into effect today in just a few moments.  Thank you, Rick Hinkley Provider Relations Representative Provider Network Management', NULL, NULL, '2021-06-07 18:23:10', '2021-06-07 18:23:10'),
(47066, 3040, 31506, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-07 16:17:19', '2021-06-07 16:17:19'),
(47067, 1005, 31506, NULL, '2021-06-15 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-06-07 16:49:09', '2021-06-07 16:49:09'),
(47068, 3040, 31506, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to:  AM.Austin@superiorhealthplan.com  Subject: Enroll Provider || Columbus Urgent Care PA || Joseph, Molly || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 09:36:25', '2021-07-20 09:36:25'),
(47069, 11056, 31506, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	AM.Austin@superiorhealthplan.com  Sub : Enroll Provider || Columbus Urgent Care PA || Joseph, Molly || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-04 14:09:33', '2021-08-04 14:09:33'),
(47070, 3040, 31506, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enroll Provider || Columbus Urgent Care PA || Joseph, Molly || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in Ambetter in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Joseph, Molly Provider NPI# 1396380077  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-27 16:25:40', '2021-08-27 16:25:40'),
(47071, 10057, 31506, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:24:13', '2021-10-11 15:24:13');
