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
(28303, 1006, 22937, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:05', '2021-03-17 16:48:05'),
(28304, 3040, 22937, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:44:58', '2021-05-26 15:44:58'),
(28305, 3040, 22937, NULL, '2021-06-10 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, '2021-06-03 08:50:18', '2021-06-03 08:50:18'),
(28306, 1006, 22938, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:06', '2021-03-17 16:48:06'),
(28307, 3040, 22938, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:02', '2021-05-26 15:45:02'),
(28308, 3040, 22938, NULL, '2021-06-10 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, '2021-06-03 08:50:23', '2021-06-03 08:50:23'),
(28309, 1006, 22939, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:07', '2021-03-17 16:48:07'),
(28310, 3040, 22939, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:06', '2021-05-26 15:45:06'),
(28311, 3040, 22939, NULL, '2021-06-10 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, '2021-06-03 08:50:28', '2021-06-03 08:50:28'),
(28312, 1006, 22940, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:08', '2021-03-17 16:48:08'),
(28313, 3040, 22940, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:10', '2021-05-26 15:45:10'),
(28314, 3040, 22940, NULL, '2021-06-10 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, '2021-06-03 08:50:33', '2021-06-03 08:50:33'),
(28315, 1006, 22941, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:09', '2021-03-17 16:48:09'),
(28316, 3040, 22941, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:13', '2021-05-26 15:45:13'),
(28317, 3040, 22941, NULL, '2021-06-10 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, '2021-06-03 08:50:37', '2021-06-03 08:50:37'),
(28318, 1006, 22942, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:10', '2021-03-17 16:48:10'),
(28319, 3040, 22942, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:17', '2021-05-26 15:45:17'),
(28320, 3040, 22942, NULL, '2021-06-10 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, '2021-06-03 08:50:41', '2021-06-03 08:50:41'),
(28321, 1006, 22943, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:11', '2021-03-17 16:48:11'),
(28322, 3040, 22943, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:21', '2021-05-26 15:45:21'),
(28323, 3040, 22943, NULL, '2021-06-10 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, '2021-06-03 08:51:50', '2021-06-03 08:51:50'),
(28324, 1006, 22944, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:13', '2021-03-17 16:48:13'),
(28325, 3040, 22944, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:25', '2021-05-26 15:45:25'),
(28326, 3040, 22944, NULL, '2021-06-10 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, '2021-06-03 08:51:53', '2021-06-03 08:51:53'),
(28327, 1006, 22945, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:14', '2021-03-17 16:48:14'),
(28328, 3040, 22945, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:28', '2021-05-26 15:45:28'),
(28329, 3040, 22945, NULL, '2021-06-10 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, '2021-06-03 08:51:59', '2021-06-03 08:51:59'),
(28330, 1006, 22946, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:15', '2021-03-17 16:48:15'),
(28331, 3040, 22946, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:32', '2021-05-26 15:45:32'),
(28332, 3040, 22946, NULL, '2021-06-10 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, '2021-06-03 08:52:03', '2021-06-03 08:52:03'),
(28333, 1006, 22947, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:48:16', '2021-03-17 16:48:16'),
(28334, 3040, 22947, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Driscoll for our group under the below locations.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-26 15:45:36', '2021-05-26 15:45:36'),
(28335, 3040, 22947, NULL, '2021-06-10 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, '2021-06-03 08:52:08', '2021-06-03 08:52:08'),
(28336, 3046, 22948, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:01', '2021-03-17 16:49:01'),
(28337, 3040, 22948, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:06', '2021-05-27 12:55:06'),
(28338, 3040, 22948, 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 14:39:04', '2021-06-15 14:39:04'),
(28339, 3040, 22948, 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 10:05:15', '2021-07-05 10:05:15'),
(28340, 3040, 22948, 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 10:01:31', '2021-07-22 10:01:31'),
(28341, 11056, 22948, 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 11:40:28', '2021-08-12 11:40:28'),
(28342, 10057, 22948, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:48:45', '2021-10-06 14:48:45'),
(28343, 10057, 22948, NULL, '2021-11-16 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, '2021-11-09 15:26:27', '2021-11-09 15:26:27'),
(28344, 10057, 22948, NULL, '2021-12-07 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, '2021-11-30 13:39:31', '2021-11-30 13:39:31'),
(28345, 10057, 22948, NULL, '2021-12-13 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, '2021-12-06 17:48:15', '2021-12-06 17:48:15'),
(28346, 10057, 22948, NULL, '2021-12-20 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, '2021-12-13 12:52:23', '2021-12-13 12:52:23'),
(28347, 10057, 22948, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:51', '2021-12-20 13:16:51'),
(28348, 10057, 22948, NULL, '2022-01-03 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, '2021-12-27 11:26:04', '2021-12-27 11:26:04'),
(28349, 19067, 22948, 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 17:43:29', '2022-01-04 17:43:29'),
(28350, 20067, 22948, 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 15:31:58', '2022-01-14 15:31:58'),
(28351, 20067, 22948, 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 10:07:44', '2022-01-24 10:07:44'),
(28352, 20067, 22948, 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 16:07:51', '2022-02-02 16:07:51');
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
(28353, 20067, 22948, 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 15:10:37', '2022-03-01 15:10:37'),
(28354, 20067, 22948, 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 17:56:12', '2022-03-17 17:56:12'),
(28355, 22077, 22948, 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 08:00:38', '2022-04-15 08:00:38'),
(28356, 22077, 22948, 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 13:24:26', '2022-04-19 13:24:26'),
(28357, 22077, 22948, 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 13:33:14', '2022-04-19 13:33:14'),
(28358, 3046, 22949, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:03', '2021-03-17 16:49:03'),
(28359, 3040, 22949, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:10', '2021-05-27 12:55:10'),
(28360, 3040, 22949, 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 14:39:00', '2021-06-15 14:39:00'),
(28361, 3040, 22949, 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 10:05:12', '2021-07-05 10:05:12'),
(28362, 3040, 22949, 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 10:01:31', '2021-07-22 10:01:31'),
(28363, 11056, 22949, 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 11:40:36', '2021-08-12 11:40:36'),
(28364, 10057, 22949, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:48:31', '2021-10-06 14:48:31'),
(28365, 10057, 22949, NULL, '2021-11-16 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, '2021-11-09 15:26:19', '2021-11-09 15:26:19'),
(28366, 10057, 22949, NULL, '2021-12-07 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, '2021-11-30 13:39:24', '2021-11-30 13:39:24'),
(28367, 10057, 22949, NULL, '2021-12-13 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, '2021-12-06 17:48:09', '2021-12-06 17:48:09'),
(28368, 10057, 22949, NULL, '2021-12-20 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, '2021-12-13 12:52:17', '2021-12-13 12:52:17'),
(28369, 10057, 22949, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:45', '2021-12-20 13:16:45'),
(28370, 10057, 22949, NULL, '2022-01-03 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, '2021-12-27 11:25:59', '2021-12-27 11:25:59'),
(28371, 19067, 22949, 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 17:43:23', '2022-01-04 17:43:23'),
(28372, 20067, 22949, 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 15:31:51', '2022-01-14 15:31:51'),
(28373, 20067, 22949, 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 10:07:36', '2022-01-24 10:07:36'),
(28374, 20067, 22949, 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 16:07:45', '2022-02-02 16:07:45'),
(28375, 20067, 22949, 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 15:10:32', '2022-03-01 15:10:32'),
(28376, 20067, 22949, 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 17:56:19', '2022-03-17 17:56:19'),
(28377, 22077, 22949, 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 08:04:44', '2022-04-15 08:04:44'),
(28378, 22077, 22949, 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 13:24:11', '2022-04-19 13:24:11'),
(28379, 22077, 22949, 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 13:33:04', '2022-04-19 13:33:04'),
(28380, 3046, 22950, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:04', '2021-03-17 16:49:04'),
(28381, 3040, 22950, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:14', '2021-05-27 12:55:14'),
(28382, 3040, 22950, 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 14:38:54', '2021-06-15 14:38:54'),
(28383, 3040, 22950, 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 10:05:10', '2021-07-05 10:05:10'),
(28384, 3040, 22950, 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 10:01:30', '2021-07-22 10:01:30'),
(28385, 11056, 22950, 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 11:40:46', '2021-08-12 11:40:46'),
(28386, 10057, 22950, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:48:11', '2021-10-06 14:48:11'),
(28387, 10057, 22950, NULL, '2021-11-16 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, '2021-11-09 15:26:13', '2021-11-09 15:26:13'),
(28388, 10057, 22950, NULL, '2021-12-07 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, '2021-11-30 13:39:16', '2021-11-30 13:39:16'),
(28389, 10057, 22950, NULL, '2021-12-13 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, '2021-12-06 17:48:04', '2021-12-06 17:48:04'),
(28390, 10057, 22950, NULL, '2021-12-20 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, '2021-12-13 12:52:12', '2021-12-13 12:52:12'),
(28391, 10057, 22950, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:40', '2021-12-20 13:16:40'),
(28392, 10057, 22950, NULL, '2022-01-03 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, '2021-12-27 11:25:53', '2021-12-27 11:25:53'),
(28393, 19067, 22950, 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 17:43:18', '2022-01-04 17:43:18'),
(28394, 20067, 22950, 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 15:31:34', '2022-01-14 15:31:34'),
(28395, 20067, 22950, 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 10:07:29', '2022-01-24 10:07:29'),
(28396, 20067, 22950, 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 16:07:40', '2022-02-02 16:07:40'),
(28397, 20067, 22950, 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 15:10:26', '2022-03-01 15:10:26'),
(28398, 20067, 22950, 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 17:56:27', '2022-03-17 17:56:27'),
(28399, 22077, 22950, 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 08:09:58', '2022-04-15 08:09:58'),
(28400, 22077, 22950, 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 13:24:01', '2022-04-19 13:24:01'),
(28401, 22077, 22950, 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 13:32:54', '2022-04-19 13:32:54'),
(28402, 3046, 22951, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:05', '2021-03-17 16:49:05');
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
(28403, 3040, 22951, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:17', '2021-05-27 12:55:17'),
(28404, 3040, 22951, 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 14:38:53', '2021-06-15 14:38:53'),
(28405, 3040, 22951, 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 10:05:07', '2021-07-05 10:05:07'),
(28406, 3040, 22951, 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 10:01:30', '2021-07-22 10:01:30'),
(28407, 11056, 22951, 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 11:40:55', '2021-08-12 11:40:55'),
(28408, 10057, 22951, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:47:56', '2021-10-06 14:47:56'),
(28409, 10057, 22951, NULL, '2021-11-16 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, '2021-11-09 15:26:05', '2021-11-09 15:26:05'),
(28410, 10057, 22951, NULL, '2021-12-07 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, '2021-11-30 13:39:06', '2021-11-30 13:39:06'),
(28411, 10057, 22951, NULL, '2021-12-13 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, '2021-12-06 17:47:58', '2021-12-06 17:47:58'),
(28412, 10057, 22951, NULL, '2021-12-20 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, '2021-12-13 12:52:06', '2021-12-13 12:52:06'),
(28413, 10057, 22951, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:34', '2021-12-20 13:16:34'),
(28414, 10057, 22951, NULL, '2022-01-03 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, '2021-12-27 11:25:47', '2021-12-27 11:25:47'),
(28415, 19067, 22951, 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 17:43:12', '2022-01-04 17:43:12'),
(28416, 20067, 22951, 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 15:31:25', '2022-01-14 15:31:25'),
(28417, 20067, 22951, 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 10:07:22', '2022-01-24 10:07:22'),
(28418, 20067, 22951, 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 16:07:32', '2022-02-02 16:07:32'),
(28419, 20067, 22951, 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 15:10:19', '2022-03-01 15:10:19'),
(28420, 20067, 22951, 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 17:56:35', '2022-03-17 17:56:35'),
(28421, 22077, 22951, 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 08:04:13', '2022-04-15 08:04:13'),
(28422, 22077, 22951, 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 13:23:52', '2022-04-19 13:23:52'),
(28423, 22077, 22951, 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 13:32:44', '2022-04-19 13:32:44'),
(28424, 3046, 22952, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:06', '2021-03-17 16:49:06'),
(28425, 3040, 22952, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:22', '2021-05-27 12:55:22'),
(28426, 3040, 22952, 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 14:38:50', '2021-06-15 14:38:50'),
(28427, 3040, 22952, 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 10:05:04', '2021-07-05 10:05:04'),
(28428, 3040, 22952, 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 10:01:29', '2021-07-22 10:01:29'),
(28429, 11056, 22952, 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 11:41:07', '2021-08-12 11:41:07'),
(28430, 10057, 22952, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:47:38', '2021-10-06 14:47:38'),
(28431, 10057, 22952, NULL, '2021-11-16 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, '2021-11-09 15:25:58', '2021-11-09 15:25:58'),
(28432, 10057, 22952, NULL, '2021-12-07 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, '2021-11-30 13:38:59', '2021-11-30 13:38:59'),
(28433, 10057, 22952, NULL, '2021-12-13 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, '2021-12-06 17:47:53', '2021-12-06 17:47:53'),
(28434, 10057, 22952, NULL, '2021-12-20 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, '2021-12-13 12:52:01', '2021-12-13 12:52:01'),
(28435, 10057, 22952, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:29', '2021-12-20 13:16:29'),
(28436, 10057, 22952, NULL, '2022-01-03 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, '2021-12-27 11:25:42', '2021-12-27 11:25:42'),
(28437, 19067, 22952, 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 17:43:05', '2022-01-04 17:43:05'),
(28438, 20067, 22952, 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 15:31:18', '2022-01-14 15:31:18'),
(28439, 20067, 22952, 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 10:07:15', '2022-01-24 10:07:15'),
(28440, 20067, 22952, 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 16:07:26', '2022-02-02 16:07:26'),
(28441, 20067, 22952, 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 15:10:14', '2022-03-01 15:10:14'),
(28442, 20067, 22952, 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 17:56:43', '2022-03-17 17:56:43'),
(28443, 22077, 22952, 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 08:07:40', '2022-04-15 08:07:40'),
(28444, 22077, 22952, 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 13:23:42', '2022-04-19 13:23:42'),
(28445, 22077, 22952, 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 13:32:33', '2022-04-19 13:32:33'),
(28446, 3046, 22953, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:08', '2021-03-17 16:49:08'),
(28447, 3040, 22953, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:26', '2021-05-27 12:55:26'),
(28448, 3040, 22953, 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 14:38:47', '2021-06-15 14:38:47'),
(28449, 3040, 22953, 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 10:05:00', '2021-07-05 10:05:00');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(28450, 3040, 22953, 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 10:01:29', '2021-07-22 10:01:29'),
(28451, 11056, 22953, 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 11:41:19', '2021-08-12 11:41:19'),
(28452, 10057, 22953, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:47:20', '2021-10-06 14:47:20'),
(28453, 10057, 22953, NULL, '2021-11-16 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, '2021-11-09 15:25:52', '2021-11-09 15:25:52'),
(28454, 10057, 22953, NULL, '2021-12-07 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, '2021-11-30 13:38:52', '2021-11-30 13:38:52'),
(28455, 10057, 22953, NULL, '2021-12-13 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, '2021-12-06 17:47:47', '2021-12-06 17:47:47'),
(28456, 10057, 22953, NULL, '2021-12-20 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, '2021-12-13 12:51:55', '2021-12-13 12:51:55'),
(28457, 10057, 22953, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:23', '2021-12-20 13:16:23'),
(28458, 10057, 22953, NULL, '2022-01-03 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, '2021-12-27 11:25:36', '2021-12-27 11:25:36'),
(28459, 19067, 22953, 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 17:42:59', '2022-01-04 17:42:59'),
(28460, 20067, 22953, 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 15:31:10', '2022-01-14 15:31:10'),
(28461, 20067, 22953, 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 10:07:08', '2022-01-24 10:07:08'),
(28462, 20067, 22953, 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 16:07:19', '2022-02-02 16:07:19'),
(28463, 20067, 22953, 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 15:10:07', '2022-03-01 15:10:07'),
(28464, 20067, 22953, 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 17:56:49', '2022-03-17 17:56:49'),
(28465, 22077, 22953, 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 08:09:09', '2022-04-15 08:09:09'),
(28466, 22077, 22953, 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 13:23:32', '2022-04-19 13:23:32'),
(28467, 22077, 22953, 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 13:32:23', '2022-04-19 13:32:23'),
(28468, 3046, 22954, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:09', '2021-03-17 16:49:09'),
(28469, 3040, 22954, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:32', '2021-05-27 12:55:32'),
(28470, 3040, 22954, 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 14:38:45', '2021-06-15 14:38:45'),
(28471, 3040, 22954, 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 10:04:57', '2021-07-05 10:04:57'),
(28472, 3040, 22954, 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 10:01:28', '2021-07-22 10:01:28'),
(28473, 11056, 22954, 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 11:41:30', '2021-08-12 11:41:30'),
(28474, 10057, 22954, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:45:45', '2021-10-06 14:45:45'),
(28475, 10057, 22954, NULL, '2021-11-16 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, '2021-11-09 15:25:46', '2021-11-09 15:25:46'),
(28476, 10057, 22954, NULL, '2021-12-07 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, '2021-11-30 13:38:44', '2021-11-30 13:38:44'),
(28477, 10057, 22954, NULL, '2021-12-13 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, '2021-12-06 17:47:41', '2021-12-06 17:47:41'),
(28478, 10057, 22954, NULL, '2021-12-20 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, '2021-12-13 12:51:49', '2021-12-13 12:51:49'),
(28479, 10057, 22954, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:19', '2021-12-20 13:16:19'),
(28480, 10057, 22954, NULL, '2022-01-03 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, '2021-12-27 11:25:29', '2021-12-27 11:25:29'),
(28481, 19067, 22954, 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 17:42:53', '2022-01-04 17:42:53'),
(28482, 20067, 22954, 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 15:31:02', '2022-01-14 15:31:02'),
(28483, 20067, 22954, 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 10:07:02', '2022-01-24 10:07:02'),
(28484, 20067, 22954, 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 16:07:12', '2022-02-02 16:07:12'),
(28485, 20067, 22954, 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 15:10:01', '2022-03-01 15:10:01'),
(28486, 20067, 22954, 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 17:56:54', '2022-03-17 17:56:54'),
(28487, 22077, 22954, 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 08:03:16', '2022-04-15 08:03:16'),
(28488, 22077, 22954, 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 13:23:17', '2022-04-19 13:23:17'),
(28489, 22077, 22954, 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 13:32:13', '2022-04-19 13:32:13'),
(28490, 3046, 22955, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:10', '2021-03-17 16:49:10'),
(28491, 3040, 22955, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:35', '2021-05-27 12:55:35'),
(28492, 3040, 22955, 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 14:38:43', '2021-06-15 14:38:43'),
(28493, 3040, 22955, 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 10:04:55', '2021-07-05 10:04:55'),
(28494, 3040, 22955, 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 10:01:28', '2021-07-22 10:01:28'),
(28495, 11056, 22955, 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 11:41:47', '2021-08-12 11:41:47'),
(28496, 10057, 22955, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:45:19', '2021-10-06 14:45:19'),
(28497, 10057, 22955, NULL, '2021-11-16 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, '2021-11-09 15:25:40', '2021-11-09 15:25:40');
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
(28498, 10057, 22955, NULL, '2021-12-07 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, '2021-11-30 13:38:38', '2021-11-30 13:38:38'),
(28499, 10057, 22955, NULL, '2021-12-13 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, '2021-12-06 17:47:33', '2021-12-06 17:47:33'),
(28500, 10057, 22955, NULL, '2021-12-20 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, '2021-12-13 12:51:43', '2021-12-13 12:51:43'),
(28501, 10057, 22955, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:14', '2021-12-20 13:16:14'),
(28502, 10057, 22955, NULL, '2022-01-03 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, '2021-12-27 11:25:22', '2021-12-27 11:25:22'),
(28503, 19067, 22955, 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 17:42:46', '2022-01-04 17:42:46'),
(28504, 20067, 22955, 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 15:30:54', '2022-01-14 15:30:54'),
(28505, 20067, 22955, 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 10:06:54', '2022-01-24 10:06:54'),
(28506, 20067, 22955, 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 16:07:05', '2022-02-02 16:07:05'),
(28507, 20067, 22955, 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 15:09:53', '2022-03-01 15:09:53'),
(28508, 20067, 22955, 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 17:57:01', '2022-03-17 17:57:01'),
(28509, 22077, 22955, 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 08:09:33', '2022-04-15 08:09:33'),
(28510, 22077, 22955, 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 13:23:07', '2022-04-19 13:23:07'),
(28511, 22077, 22955, 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 13:32:05', '2022-04-19 13:32:05'),
(28512, 3046, 22956, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:12', '2021-03-17 16:49:12'),
(28513, 3040, 22956, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:39', '2021-05-27 12:55:39'),
(28514, 3040, 22956, 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 14:38:41', '2021-06-15 14:38:41'),
(28515, 3040, 22956, 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 10:04:52', '2021-07-05 10:04:52'),
(28516, 3040, 22956, 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 10:01:27', '2021-07-22 10:01:27'),
(28517, 11056, 22956, 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 11:41:54', '2021-08-12 11:41:54'),
(28518, 10057, 22956, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:45:05', '2021-10-06 14:45:05'),
(28519, 10057, 22956, NULL, '2021-11-16 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, '2021-11-09 15:25:34', '2021-11-09 15:25:34'),
(28520, 10057, 22956, NULL, '2021-12-07 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, '2021-11-30 13:38:30', '2021-11-30 13:38:30'),
(28521, 10057, 22956, NULL, '2021-12-13 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, '2021-12-06 17:47:27', '2021-12-06 17:47:27'),
(28522, 10057, 22956, NULL, '2021-12-20 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, '2021-12-13 12:51:37', '2021-12-13 12:51:37'),
(28523, 10057, 22956, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:09', '2021-12-20 13:16:09'),
(28524, 10057, 22956, NULL, '2022-01-03 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, '2021-12-27 11:25:14', '2021-12-27 11:25:14'),
(28525, 19067, 22956, 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 17:42:41', '2022-01-04 17:42:41'),
(28526, 20067, 22956, 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 15:30:47', '2022-01-14 15:30:47'),
(28527, 20067, 22956, 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 10:06:48', '2022-01-24 10:06:48'),
(28528, 20067, 22956, 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 16:06:57', '2022-02-02 16:06:57'),
(28529, 20067, 22956, 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 15:09:48', '2022-03-01 15:09:48'),
(28530, 20067, 22956, 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 17:57:06', '2022-03-17 17:57:06'),
(28531, 22077, 22956, 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 08:10:27', '2022-04-15 08:10:27'),
(28532, 22077, 22956, 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 13:22:55', '2022-04-19 13:22:55'),
(28533, 22077, 22956, 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 13:31:54', '2022-04-19 13:31:54'),
(28534, 3046, 22957, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:13', '2021-03-17 16:49:13'),
(28535, 3040, 22957, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:43', '2021-05-27 12:55:43'),
(28536, 3040, 22957, 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 14:38:39', '2021-06-15 14:38:39'),
(28537, 3040, 22957, 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 10:04:49', '2021-07-05 10:04:49'),
(28538, 3040, 22957, 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 10:01:27', '2021-07-22 10:01:27'),
(28539, 11056, 22957, 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 11:42:03', '2021-08-12 11:42:03'),
(28540, 10057, 22957, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:44:47', '2021-10-06 14:44:47'),
(28541, 10057, 22957, NULL, '2021-11-16 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, '2021-11-09 15:25:28', '2021-11-09 15:25:28'),
(28542, 10057, 22957, NULL, '2021-12-07 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, '2021-11-30 13:38:22', '2021-11-30 13:38:22'),
(28543, 10057, 22957, NULL, '2021-12-13 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, '2021-12-06 17:47:21', '2021-12-06 17:47:21'),
(28544, 10057, 22957, NULL, '2021-12-20 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, '2021-12-13 12:51:32', '2021-12-13 12:51:32'),
(28545, 10057, 22957, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:16:03', '2021-12-20 13:16:03'),
(28546, 10057, 22957, NULL, '2022-01-03 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, '2021-12-27 11:25:08', '2021-12-27 11:25:08');
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
(28547, 19067, 22957, 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 17:42:36', '2022-01-04 17:42:36'),
(28548, 20067, 22957, 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 15:30:41', '2022-01-14 15:30:41'),
(28549, 20067, 22957, 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 10:06:41', '2022-01-24 10:06:41'),
(28550, 20067, 22957, 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 16:06:49', '2022-02-02 16:06:49'),
(28551, 20067, 22957, 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 15:09:34', '2022-03-01 15:09:34'),
(28552, 20067, 22957, 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 17:57:13', '2022-03-17 17:57:13'),
(28553, 22077, 22957, 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 08:05:13', '2022-04-15 08:05:13'),
(28554, 22077, 22957, 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 13:22:45', '2022-04-19 13:22:45'),
(28555, 22077, 22957, 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 13:31:44', '2022-04-19 13:31:44'),
(28556, 3046, 22958, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:14', '2021-03-17 16:49:14'),
(28557, 3040, 22958, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:47', '2021-05-27 12:55:47'),
(28558, 3040, 22958, 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 14:38:36', '2021-06-15 14:38:36'),
(28559, 3040, 22958, 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 10:04:47', '2021-07-05 10:04:47'),
(28560, 3040, 22958, 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 10:01:26', '2021-07-22 10:01:26'),
(28561, 11056, 22958, 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 11:40:20', '2021-08-12 11:40:20'),
(28562, 10057, 22958, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:44:28', '2021-10-06 14:44:28'),
(28563, 10057, 22958, NULL, '2021-11-16 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, '2021-11-09 15:25:23', '2021-11-09 15:25:23'),
(28564, 10057, 22958, NULL, '2021-12-07 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, '2021-11-30 13:38:14', '2021-11-30 13:38:14'),
(28565, 10057, 22958, NULL, '2021-12-13 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, '2021-12-06 17:47:16', '2021-12-06 17:47:16'),
(28566, 10057, 22958, NULL, '2021-12-20 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, '2021-12-13 12:51:25', '2021-12-13 12:51:25'),
(28567, 10057, 22958, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:58', '2021-12-20 13:15:58'),
(28568, 10057, 22958, NULL, '2022-01-03 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, '2021-12-27 11:25:03', '2021-12-27 11:25:03'),
(28569, 19067, 22958, 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 17:42:30', '2022-01-04 17:42:30'),
(28570, 20067, 22958, 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 15:30:31', '2022-01-14 15:30:31'),
(28571, 20067, 22958, 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 10:06:35', '2022-01-24 10:06:35'),
(28572, 20067, 22958, 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 16:06:42', '2022-02-02 16:06:42'),
(28573, 20067, 22958, 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 15:09:26', '2022-03-01 15:09:26'),
(28574, 20067, 22958, 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 17:57:19', '2022-03-17 17:57:19'),
(28575, 22077, 22958, 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 08:03:44', '2022-04-15 08:03:44'),
(28576, 22077, 22958, 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 13:22:31', '2022-04-19 13:22:31'),
(28577, 22077, 22958, 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 13:31:35', '2022-04-19 13:31:35'),
(28578, 3046, 22959, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:16', '2021-03-17 16:49:16'),
(28579, 3040, 22959, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:51', '2021-05-27 12:55:51'),
(28580, 3040, 22959, 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 14:38:34', '2021-06-15 14:38:34'),
(28581, 3040, 22959, 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 10:04:45', '2021-07-05 10:04:45'),
(28582, 3040, 22959, 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 10:01:26', '2021-07-22 10:01:26'),
(28583, 11056, 22959, 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 11:40:11', '2021-08-12 11:40:11'),
(28584, 10057, 22959, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:44:17', '2021-10-06 14:44:17'),
(28585, 10057, 22959, NULL, '2021-11-16 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, '2021-11-09 15:25:17', '2021-11-09 15:25:17'),
(28586, 10057, 22959, NULL, '2021-12-07 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, '2021-11-30 13:38:07', '2021-11-30 13:38:07'),
(28587, 10057, 22959, NULL, '2021-12-13 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, '2021-12-06 17:47:10', '2021-12-06 17:47:10'),
(28588, 10057, 22959, NULL, '2021-12-20 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, '2021-12-13 12:51:20', '2021-12-13 12:51:20'),
(28589, 10057, 22959, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:51', '2021-12-20 13:15:51'),
(28590, 10057, 22959, NULL, '2022-01-03 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, '2021-12-27 11:24:57', '2021-12-27 11:24:57'),
(28591, 19067, 22959, 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 17:42:24', '2022-01-04 17:42:24'),
(28592, 20067, 22959, 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 15:30:25', '2022-01-14 15:30:25'),
(28593, 20067, 22959, 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 10:06:29', '2022-01-24 10:06:29'),
(28594, 20067, 22959, 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 16:06:36', '2022-02-02 16:06:36');
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
(28595, 20067, 22959, 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 15:09:17', '2022-03-01 15:09:17'),
(28596, 20067, 22959, 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 17:57:25', '2022-03-17 17:57:25'),
(28597, 22077, 22959, 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 08:05:41', '2022-04-15 08:05:41'),
(28598, 22077, 22959, 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 13:21:53', '2022-04-19 13:21:53'),
(28599, 22077, 22959, 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 13:31:24', '2022-04-19 13:31:24'),
(28600, 3046, 22960, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:17', '2021-03-17 16:49:17'),
(28601, 3040, 22960, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:55:55', '2021-05-27 12:55:55'),
(28602, 3040, 22960, 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 14:38:32', '2021-06-15 14:38:32'),
(28603, 3040, 22960, 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 10:04:42', '2021-07-05 10:04:42'),
(28604, 3040, 22960, 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 10:01:26', '2021-07-22 10:01:26'),
(28605, 11056, 22960, 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 11:40:02', '2021-08-12 11:40:02'),
(28606, 10057, 22960, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:44:04', '2021-10-06 14:44:04'),
(28607, 10057, 22960, NULL, '2021-11-16 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, '2021-11-09 15:25:10', '2021-11-09 15:25:10'),
(28608, 10057, 22960, NULL, '2021-12-07 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, '2021-11-30 13:37:59', '2021-11-30 13:37:59'),
(28609, 10057, 22960, NULL, '2021-12-13 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, '2021-12-06 17:47:05', '2021-12-06 17:47:05'),
(28610, 10057, 22960, NULL, '2021-12-20 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, '2021-12-13 12:51:13', '2021-12-13 12:51:13'),
(28611, 10057, 22960, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:46', '2021-12-20 13:15:46'),
(28612, 10057, 22960, NULL, '2022-01-03 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, '2021-12-27 11:24:52', '2021-12-27 11:24:52'),
(28613, 19067, 22960, 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 17:42:18', '2022-01-04 17:42:18'),
(28614, 20067, 22960, 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 15:30:18', '2022-01-14 15:30:18'),
(28615, 20067, 22960, 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 10:06:23', '2022-01-24 10:06:23'),
(28616, 20067, 22960, 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 16:06:28', '2022-02-02 16:06:28'),
(28617, 20067, 22960, 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 15:09:10', '2022-03-01 15:09:10'),
(28618, 20067, 22960, 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 17:57:31', '2022-03-17 17:57:31'),
(28619, 22077, 22960, 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 08:10:53', '2022-04-15 08:10:53'),
(28620, 22077, 22960, 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 13:21:44', '2022-04-19 13:21:44'),
(28621, 22077, 22960, 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 13:30:39', '2022-04-19 13:30:39'),
(28622, 3046, 22961, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:20', '2021-03-17 16:49:20'),
(28623, 3040, 22961, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:56:03', '2021-05-27 12:56:03'),
(28624, 3040, 22961, 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 14:38:30', '2021-06-15 14:38:30'),
(28625, 3040, 22961, 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 10:04:40', '2021-07-05 10:04:40'),
(28626, 3040, 22961, 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 10:01:25', '2021-07-22 10:01:25'),
(28627, 11056, 22961, 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 11:39:52', '2021-08-12 11:39:52'),
(28628, 10057, 22961, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:43:44', '2021-10-06 14:43:44'),
(28629, 10057, 22961, NULL, '2021-11-16 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, '2021-11-09 15:25:04', '2021-11-09 15:25:04'),
(28630, 10057, 22961, NULL, '2021-12-07 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, '2021-11-30 13:37:51', '2021-11-30 13:37:51'),
(28631, 10057, 22961, NULL, '2021-12-13 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, '2021-12-06 17:46:59', '2021-12-06 17:46:59'),
(28632, 10057, 22961, NULL, '2021-12-20 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, '2021-12-13 12:51:02', '2021-12-13 12:51:02'),
(28633, 10057, 22961, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:41', '2021-12-20 13:15:41'),
(28634, 10057, 22961, NULL, '2022-01-03 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, '2021-12-27 11:24:45', '2021-12-27 11:24:45'),
(28635, 19067, 22961, 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 17:42:13', '2022-01-04 17:42:13'),
(28636, 20067, 22961, 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 15:30:11', '2022-01-14 15:30:11'),
(28637, 20067, 22961, 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 10:06:14', '2022-01-24 10:06:14'),
(28638, 20067, 22961, 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 16:06:22', '2022-02-02 16:06:22'),
(28639, 20067, 22961, 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 15:09:04', '2022-03-01 15:09:04'),
(28640, 20067, 22961, 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 17:57:37', '2022-03-17 17:57:37'),
(28641, 22077, 22961, 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 08:08:41', '2022-04-15 08:08:41'),
(28642, 22077, 22961, 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 13:21:33', '2022-04-19 13:21:33'),
(28643, 22077, 22961, 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 13:30:29', '2022-04-19 13:30:29'),
(28644, 19067, 22961, NULL, '2022-04-29 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group.', NULL, NULL, '2022-04-22 11:26:07', '2022-04-22 11:26:07'),
(28645, 3046, 22962, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:22', '2021-03-17 16:49:22');
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
(28646, 3040, 22962, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:56:07', '2021-05-27 12:56:07'),
(28647, 3040, 22962, 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 14:38:28', '2021-06-15 14:38:28'),
(28648, 3040, 22962, 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 10:04:37', '2021-07-05 10:04:37'),
(28649, 3040, 22962, 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 10:01:25', '2021-07-22 10:01:25'),
(28650, 11056, 22962, 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 11:39:43', '2021-08-12 11:39:43'),
(28651, 10057, 22962, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:31:37', '2021-10-06 14:31:37'),
(28652, 10057, 22962, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:33:34', '2021-10-06 14:33:34'),
(28653, 10057, 22962, NULL, '2021-11-16 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, '2021-11-09 15:24:58', '2021-11-09 15:24:58'),
(28654, 10057, 22962, NULL, '2021-12-07 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, '2021-11-30 13:37:43', '2021-11-30 13:37:43'),
(28655, 10057, 22962, NULL, '2021-12-13 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, '2021-12-06 17:46:53', '2021-12-06 17:46:53'),
(28656, 10057, 22962, NULL, '2021-12-20 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, '2021-12-13 12:50:55', '2021-12-13 12:50:55'),
(28657, 10057, 22962, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:34', '2021-12-20 13:15:34'),
(28658, 10057, 22962, NULL, '2022-01-03 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, '2021-12-27 11:24:40', '2021-12-27 11:24:40'),
(28659, 19067, 22962, 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 17:42:08', '2022-01-04 17:42:08'),
(28660, 20067, 22962, 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 15:30:05', '2022-01-14 15:30:05'),
(28661, 20067, 22962, 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 10:06:05', '2022-01-24 10:06:05'),
(28662, 20067, 22962, 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 16:06:15', '2022-02-02 16:06:15'),
(28663, 20067, 22962, 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 15:08:59', '2022-03-01 15:08:59'),
(28664, 20067, 22962, 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 17:57:44', '2022-03-17 17:57:44'),
(28665, 22077, 22962, 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 08:08:03', '2022-04-15 08:08:03'),
(28666, 22077, 22962, 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 13:21:23', '2022-04-19 13:21:23'),
(28667, 22077, 22962, 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 13:30:20', '2022-04-19 13:30:20'),
(28668, 3046, 22963, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:49:23', '2021-03-17 16:49:23'),
(28669, 3040, 22963, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:56:12', '2021-05-27 12:56:12'),
(28670, 3040, 22963, 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 14:38:26', '2021-06-15 14:38:26'),
(28671, 3040, 22963, 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 10:04:35', '2021-07-05 10:04:35'),
(28672, 3040, 22963, 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 10:01:24', '2021-07-22 10:01:24'),
(28673, 11056, 22963, 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 11:39:36', '2021-08-12 11:39:36'),
(28674, 10057, 22963, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Hope this email finds you well, I\'m writing this email to let you know that I\'m unable to find any attachments or forms in your previous email, please check from your side as well.  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:30:23', '2021-10-06 14:30:23'),
(28675, 10057, 22963, NULL, '2021-11-16 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, '2021-11-09 15:24:51', '2021-11-09 15:24:51'),
(28676, 10057, 22963, NULL, '2021-12-07 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, '2021-11-30 13:37:18', '2021-11-30 13:37:18'),
(28677, 10057, 22963, NULL, '2021-12-21 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, '2021-12-14 11:04:08', '2021-12-14 11:04:08'),
(28678, 10057, 22963, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Follow-up Sent.', NULL, NULL, '2021-12-20 13:15:28', '2021-12-20 13:15:28'),
(28679, 10057, 22963, NULL, '2022-01-03 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, '2021-12-27 11:24:34', '2021-12-27 11:24:34'),
(28680, 19067, 22963, 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 17:42:03', '2022-01-04 17:42:03'),
(28681, 20067, 22963, 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 15:29:57', '2022-01-14 15:29:57'),
(28682, 20067, 22963, 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 10:05:59', '2022-01-24 10:05:59'),
(28683, 20067, 22963, 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 16:06:09', '2022-02-02 16:06:09'),
(28684, 20067, 22963, 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 15:08:54', '2022-03-01 15:08:54'),
(28685, 20067, 22963, 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 17:57:56', '2022-03-17 17:57:56'),
(28686, 22077, 22963, 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 08:06:18', '2022-04-15 08:06:18'),
(28687, 22077, 22963, 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 13:21:13', '2022-04-19 13:21:13'),
(28688, 22077, 22963, 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 13:30:11', '2022-04-19 13:30:11'),
(28689, 3046, 22964, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:24', '2021-03-17 16:52:24'),
(28690, 1006, 22964, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'HealthSmart does not enroll groups separately, Anci-Care is responsible for group/facility enrollment. ', NULL, NULL, '2021-05-20 12:23:59', '2021-05-20 12:23:59'),
(28691, 3046, 22965, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:25', '2021-03-17 16:52:25'),
(28692, 3040, 22965, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  09/01/2019  Ref: 2044922', NULL, NULL, '2021-05-27 15:36:44', '2021-05-27 15:36:44'),
(28693, 3046, 22966, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:27', '2021-03-17 16:52:27'),
(28694, 3040, 22966, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  02/01/2018  Ref: 2044922', NULL, NULL, '2021-05-27 15:35:53', '2021-05-27 15:35:53'),
(28695, 3046, 22967, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:28', '2021-03-17 16:52:28'),
(28696, 3040, 22967, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  05/01/2020', NULL, NULL, '2021-05-27 14:57:33', '2021-05-27 14:57:33'),
(28697, 3046, 22968, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:30', '2021-03-17 16:52:30'),
(28698, 3040, 22968, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Request for participation submitted online.   Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.  ', NULL, NULL, '2021-05-27 16:00:59', '2021-05-27 16:00:59'),
(28699, 11056, 22968, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Sent follow up email @ pr.south@healthsmart.com:  Sub: Enrollment status - NUCC/ IVUC - Health Smart  \"Good morning!  What is the status of enrollment for our providers under the below mentioned group their information is given below:- Group Name: Normandy Urgent Care CenterMain Address: 779 Normandy St Ste 114, Houston, TX 77015-3441Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060TIN: 27-0796429      NPI: 1407171077 Provider Name: Paul, SigiProvider NPI# 1033623616 Provider Name: Jacob,JayaProvider NPI# 1194336149 Provider Name:Chennemkara,MiniProvider NPI#  1841755956 Please get back to me as soon as possible. Thank you!\" ', NULL, NULL, '2021-06-16 10:52:04', '2021-06-16 10:52:04'),
(28700, 11056, 22968, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : Enrollment status Updates Hi,   Below providers are currently in the credentialing process.  Providers Name Chennemkara, Mini P FNP PAUL, SIGI FNP Jacob, Jaya FNP  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80638)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-06-18 11:11:01', '2021-06-18 11:11:01'),
(28701, 3040, 22968, NULL, '2021-07-09 00:00:00.000', 'Approved', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Anci Care ||  Hi,   1. Please see below providers effective date.  Providers Name  Effective Date  PAUL, SIGI C  06/01/2021  CHENNEMKARA, MINI P  06/17/2021  ', NULL, NULL, '2021-07-02 09:37:35', '2021-07-02 09:37:35'),
(28702, 3046, 22969, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:31', '2021-03-17 16:52:31'),
(28703, 3040, 22969, NULL, '2021-06-03 00:00:00.000', 'New/Not Initiated', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date:  03/11/2020 ', NULL, NULL, '2021-05-27 14:58:26', '2021-05-27 14:58:26'),
(28704, 3040, 22969, NULL, '2021-06-03 00:00:00.000', 'Approved', 'I had a word with (Katrina) Health Smart representative and she advised me the provider is in network with Health Smart.   Effective Date: 03/11/2020', NULL, NULL, '2021-05-27 14:58:56', '2021-05-27 14:58:56'),
(28705, 3046, 22970, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-17 16:52:33', '2021-03-17 16:52:33');
