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
(20604, 22077, 21781, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:21:17', '2022-04-05 10:21:17'),
(20605, 1006, 21782, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:06', '2021-03-16 10:55:06'),
(20606, 3040, 21782, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:46', '2021-04-21 08:18:46'),
(20607, 1019, 21782, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:32:53', '2021-11-09 10:32:53'),
(20608, 1006, 21783, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:08', '2021-03-16 10:55:08'),
(20609, 3040, 21783, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:18:14', '2021-04-21 08:18:14'),
(20610, 1006, 21784, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:09', '2021-03-16 10:55:09'),
(20611, 1019, 21784, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Sent email to MBHPNetworkOperations@beaconhealthoptions.com Sub: Enroll Provider || SNBCARE || Kerry Smith || MBHP   Hello, We wanted to enroll the below mentioned provider in MBHP, under our group. Can you let us know if you do enroll these types of provider.  Group Information: Spectrum Neuro Behavioral Care LLC Tax ID: 834482753 NPI: 1356906572 Individual Provider:  Kerry Smith NPI: 1275083230 Specialty: Licensed Clinical Social Worker', NULL, NULL, '2021-04-02 14:31:46', '2021-04-02 14:31:46'),
(20612, 3040, 21784, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Spoke to Furquan regarding this, providers will do their cultural competency and update me when that has been completed so we can move forward with this request.  ', NULL, NULL, '2021-04-21 08:19:21', '2021-04-21 08:19:21'),
(20613, 1006, 21785, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:11', '2021-03-16 10:55:11'),
(20614, 3040, 21785, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Waiting for location addition once the location added in the group contract after that we can request for provider to add in the additional location. ', NULL, NULL, '2021-04-21 08:23:55', '2021-04-21 08:23:55'),
(20615, 1019, 21785, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:32:44', '2021-06-04 15:32:44'),
(20616, 1019, 21785, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:48:40', '2021-06-23 10:48:40'),
(20617, 19067, 21785, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:01:54', '2021-12-13 15:01:54'),
(20618, 19067, 21785, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:36', '2021-12-29 13:44:36'),
(20619, 19067, 21785, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:46:00', '2021-12-29 13:46:00'),
(20620, 19067, 21785, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:05:08', '2022-01-10 14:05:08'),
(20621, 19067, 21785, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:13', '2022-02-11 10:45:13'),
(20622, 19067, 21785, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:06', '2022-02-15 09:48:06'),
(20623, 19067, 21785, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:28', '2022-03-16 17:12:28'),
(20624, 22077, 21785, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:11:11', '2022-04-05 08:11:11'),
(20625, 22077, 21785, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:21:38', '2022-04-05 10:21:38'),
(20626, 1006, 21786, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:12', '2021-03-16 10:55:12'),
(20627, 3040, 21786, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Email sent to: MNHPnetworkoperations@beaconhealthoption.com  Subject: Enroll Providers || Spectrum Neuro Behavioral Care LLC || Rashid, Mahreen & Ullrich, Jennifer Lee || MBHP ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers for our group   Spectrum Neuro Behavioral Care LLC under below locations.   Practice Details: Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702 Secondary Address: 100 New State Hwy. Raynham , MA 02767  Provider 1: Provider Name: Rashid, Mahreen Provider NPI# 1396393146  Provider 2:   Provider Name: Ullrich, Jennifer Lee Provider NPI# 1710489760  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-21 08:16:21', '2021-04-21 08:16:21'),
(20628, 1019, 21786, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent the following email to MBHPnetworkoperations@beaconhealthoption.com SUB: Enrollment Query || Providers || MBHP || SNBCARE  Good Afternoon, We need the enrollment status for the following providers under our group.  Group Information:  Practice Name: Spectrum Neuro Behavioral Care LLC Practice Tax ID# 83-4482753 Practice NPI# 1356906572 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Providers:  Jennifer Ullrich NPI: 1710489760 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Katie Tawakol NPI: 1609222116 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Mahreen Rashid NPI: 1396393146 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Prisca Hefti NPI: 1508133182 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Peggy Pionke NPI: 1699307322 Primary Address: 61 Lincoln St., Suite 203, Framingham , MA 01702. Secondary Address: 100 New State Hwy. Raynham , MA 02767.  Regards,', NULL, NULL, '2021-06-04 15:32:19', '2021-06-04 15:32:19'),
(20629, 1019, 21786, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Spoken with Rep Ashley M, regarding enrolling issue as MBHP wasn\'t getting back to us, so she sent a request from her side to enroll the following providers with MBHP. Waiting for MBHP email now. Call Ref # Ashley M 06/16/2021 - 6765376', NULL, NULL, '2021-06-23 10:48:31', '2021-06-23 10:48:31'),
(20630, 19067, 21786, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Provider Enrollment Status  Hi,  Hope you\'re having a productive day.  I want to know Credentialing status for providers below:  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Primary Location	61 Lincoln St., Suite 203, Framingham, MA 01702. Secondary Location	100 New State Hwy. Raynham, MA 02767 Provider Name	NPI Jennifer Ullrich	1710489760 Katie Tawakol 1609222116 Mehreen Rashid 1396393146 Prisca Hefti 1508133182                                  Peggy Pionke	1699307322  Kindly get back to me as soon as possible.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-13 15:01:29', '2021-12-13 15:01:29'),
(20631, 19067, 21786, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Hello!  Hope you\'re doing well.  I would like to know the enrollment status of the following Providers and Group as well as with MBHP.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Peggy Pionke	1699307322	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Katie Tawakol	1609222116	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Mahreen Rashid	1396393146	61 Lincoln St., Suite 203, Framingham, MA 01702-8264 Mahreen Rashid	1396393146	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Prisca Hefti	1508133182	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Jennifer Ullrich	1710489760	61 Lincoln St., Suite 203, Framingham, MA 01702-8264   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 13:44:56', '2021-12-29 13:44:56'),
(20632, 19067, 21786, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: MBHPnetworkoperations@beaconhealthoption.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Greetings!  Any updates on the previously mentioned request?   Kindly get back to us once you have time.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 14:04:52', '2022-01-10 14:04:52'),
(20633, 19067, 21786, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hello,  I would like to know the enrollment status of the previously mentioned request.   Regards.', NULL, NULL, '2022-02-11 10:45:08', '2022-02-11 10:45:08'),
(20634, 19067, 21786, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: 	RE: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Ahmed,     The below providers that will need to complete the form, please indicate in the service section they want to add MBHP line of insurance.     Peggy Pionke – Complete the attached form  Katie Tawakolv – Already in network  Mahreen Rashid – Complete the attached form  Prisca Hefti – Already in network  Jennifer Ullrich – Complete the attached form     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159', NULL, NULL, '2022-02-15 09:48:36', '2022-02-15 09:48:36'),
(20635, 19067, 21786, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Re: Enrollment Status || SNBCARE || Providers & Group || MBHP ||   Hi Randy,  Please provide an effective date and approval letter for the providers who are now in-network with MBHP.   Thanks, Hammad Ahmed', NULL, NULL, '2022-03-16 17:12:39', '2022-03-16 17:12:39'),
(20636, 22077, 21786, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email sent to: Randy.Tarpley@beaconhealthoptions.com  Subject: Fwd: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Good Morning,  Kindly see the attached file as requested  Thanks', NULL, NULL, '2022-04-05 08:12:28', '2022-04-05 08:12:28'),
(20637, 22077, 21786, NULL, '2022-04-12 00:00:00.000', 'In Process', 'Email received from: Randy.Tarpley@beaconhealthoptions.com  Subject: Enrollment Status || SNBCARE || Providers & Group || MBHP ||  Received, thank you.     Randy Tarpley  Network Management Rep I, MBHP  –––––––––––––––––––––––  Beacon Health Options  1000 Washington Street, Suite 310  Boston, MA 02118  Office: 1.800.495.0086  Direct Line: 617-790-4159  Please note my last day with company is 4/8/2022  Please direct any questions to mbhp_pr@beaconhealthoptions.com ', NULL, NULL, '2022-04-05 10:21:55', '2022-04-05 10:21:55'),
(20638, 3040, 21787, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:14', '2021-03-16 10:55:14'),
(20639, 3040, 21787, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:37', '2021-05-28 12:31:37'),
(20640, 3046, 21788, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:24', '2021-03-16 10:55:24'),
(20641, 1006, 21788, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Submitted LOI & W9 for addition location to Urgentcare contract. Sent email @ pdsdallas@aetna.com ', NULL, NULL, '2021-03-25 17:32:54', '2021-03-25 17:32:54'),
(20642, 9057, 21788, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: pdsdallas@aetna.com Sub: Additional location status request - RHC - First Health  Hello, We submitted a request for additional location to our urgent care contract under the following group  and providers.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provide Details Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415     Provider 3: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 4: Provider Name: Trevino, Rose Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363   Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :5 Provider Name: Ayarzagoitia, Patrick  Provider NPI#   1649568239 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :6 Provider Name: Mason, Traci Provider NPI#   1497127831 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider :7 Provider Name: Svatek, Maegan Provider NPI#   1639670250 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:8 Provider Name: Capupus, Mari Provider NPI#   NPI: 1740517945 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider:9 Provider Name: Rogers, Petina Provider NPI#   1801443916 Additional  Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Kindly provide the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 13:10:03', '2021-05-26 13:10:03'),
(20643, 3040, 21788, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: pdsdallas@aetna.com  Subject: Additional location status request - RHC - First Health  Hello,   I wanted to get an update on the status of this request, please get back to me as soon as possible.  Thank you! ', NULL, NULL, '2021-06-15 16:31:04', '2021-06-15 16:31:04'),
(20644, 11056, 21788, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email received from : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Brad,  Please share practice location phone and Fax numbers so that we can proceed further.  Regards, Bharath  Email sent to : BharathB@aetna.com  Sub : Additional location status request - RHC - First Health  Hi Bharath,  Hope you are doing well. Here is the information you asked for about the practice.  Practice Detail: Practice Name : Statcare Minor Emergency Clinic Practice Phone : 361-516-0800 Practice Fax : 361-516-0855   If you need any further information feel free to contact me. Waiting to hear from you soon. Thank you! ', NULL, NULL, '2021-07-01 14:58:05', '2021-07-01 14:58:05'),
(20645, 1006, 21788, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from Bharath, Bollu BharathB@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hi Brad,  Following up on the below email. Please assist  Regards, Bharath\"  Replied:   \"Hello Bollu,   Sure thing, here\'s the information: Address: 500 E CAESAR, KINGSVILLE, TX 78363   Phone# 361-516-0800 Fax# 361-516-0855  Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415 Phone#  361-334-2035 Fax# 361-334-2038  Please let me know if anything else is required.  Thank you. \"', NULL, NULL, '2021-07-07 08:51:37', '2021-07-07 08:51:37'),
(20646, 1006, 21788, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent f/u email @ \"Bharath, Bollu\" BharathB@aetna.com & pdsdallas@aetna.com:  Sub: Additional location status request - RHC - First Health  \"Hello Bollu,   I appreciate the update, from what I can see from the First Health directory there seems to have been some confusion.   We want all of the following mentioned practice addresses listed under all of the given providers:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  Please let me know if you need anything to get these updated.  Thank you.\"', NULL, NULL, '2021-08-17 17:28:12', '2021-08-17 17:28:12'),
(20647, 11056, 21788, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : pdsdallas@aetna.com>  Sub : Fwd: Additional location status request - RHC - First Health  Good evening!  Hope all is well with you. I want all of the following mentioned practice addresses listed under all of the given providers. Please update me with the latest credentialing status of these providers too.  Practice Details: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details: Provider Name: Rose Trevino NPI# 1437174794  Provider Name: Katherine Rabagos NPI# 1134415631  Provider Name: Mary Gonzalez NPI# 1952713083  Provider Name: William Francis NPI# 1457994436  Provider Name: Juan Capupus NPI# 1891168597  Provider Name: Maegan Svatek NPI# 1639670250  Provider Name: Petina Rogers NPI# 1801443916  Provider Name: Traci Mason NPI# 1497127831  Provider Name: Mari Capupus NPI# 1740517945  Provider Name: Patrick Ayarzagoitia NPI# 1649568239  If you have any questions or concerns or require any documents or information, please contact me without any hesitation. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:26:34', '2021-09-21 16:26:34'),
(20648, 11056, 21788, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : MadirajuP@aetna.com  Sub : Fwd: Additional location status request - RHC - First Health  Hi,  All the Providers has been added with the given locations.   Thank You,  Phani ', NULL, NULL, '2021-10-01 14:41:14', '2021-10-01 14:41:14'),
(20649, 11056, 21788, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub  : Fwd: Additional location status request - RHC - First Health  Good morning!  Hope you are doing great. Please provide the approval letters and executed contract for the facility & providers as soon as possible. I will be eagerly waiting for it.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-10-13 16:49:48', '2021-10-13 16:49:48'),
(20650, 11056, 21788, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email received from : SidleyJ1@firsthealth.com  Sub : Fwd: Additional location status request - RHC - First Health  Hello Ahmed,    I hope that this email finds you well!  Please see attached copy of the contract on file for the practice. The practices group ID when submitting updates to the Data Team is 1067518.   I personally did not send out the welcome letter so I do not have the file to send over. The welcome letters during that time are outdated now so the information would be different than what we currently use. Any of the welcome letters that I have recently sent have the updated information to reference. Please make sure to always list the group ID number so that the Data Team can locate the file easier and your requests process faster.  I hope that this helps!  Take care,  Jeanette Sidley Network Relations Consultant', NULL, NULL, '2021-10-20 14:33:38', '2021-10-20 14:33:38'),
(20651, 11056, 21788, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to : SidleyJ1@firsthealth.com  Sub : RE: [SEND SECURE] RE: [EXTERNAL] Re: Additional location status request - RHC - First Health Fwd: Additional location status request - RHC - First Health  Good morning!     Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that the all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.     Kindly do us a favor. Confirm with the Effective Dates soon.     Thank you!  Have a wonderful day!     Practice Name: Statcare Minor Emergency Clinic  NPI# 1689924904  TIN# 46-0575924     Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363  Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413  Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410  Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415', NULL, NULL, '2021-11-10 17:39:03', '2021-11-10 17:39:03'),
(20652, 11056, 21788, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Lynn M  Status: Have placed a request for the group agreement for us.  Refcode: 11222021 ', NULL, NULL, '2021-11-24 15:45:17', '2021-11-24 15:45:17'),
(20653, 11056, 21788, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email sent to:  pdsdallas@aetna.com  Sub: Fwd: Additional location status request - RHC - First Health  Good afternoon!   Hope you are doing great. We have four locations under the facility tax I.D. Two of them are already listed under the providers and facility but the other highlighted ones were remaining. Miss Phani informed us that all locations are loaded, therefore, we need the effective dates and some kind of letter for proof for our providers.  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415    Kindly do us a favor. Confirm with the Effective Dates soon.    Thank you! Have a wonderful day!', NULL, NULL, '2021-12-10 17:29:32', '2021-12-10 17:29:32'),
(20654, 11056, 21788, NULL, '2021-12-23 00:00:00.000', 'Approved', 'Rep: Lynn M  Status: Approved and effective 11/01/2019. Urgent Care Contract.  Please see the attached agreement.  Refcode: 12162021lynnm', NULL, NULL, '2021-12-16 17:04:39', '2021-12-16 17:04:39'),
(20655, 3040, 21789, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:34', '2021-03-16 10:55:34'),
(20656, 3040, 21789, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:40', '2021-05-28 12:31:40'),
(20657, 3040, 21790, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:55:50', '2021-03-16 10:55:50'),
(20658, 3040, 21790, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:44', '2021-05-28 12:31:44'),
(20659, 3040, 21791, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:56:00', '2021-03-16 10:56:00'),
(20660, 3040, 21791, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:47', '2021-05-28 12:31:47'),
(20661, 3040, 21792, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:56:19', '2021-03-16 10:56:19'),
(20662, 3040, 21792, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:51', '2021-05-28 12:31:51'),
(20663, 3040, 21793, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:56:37', '2021-03-16 10:56:37'),
(20664, 3040, 21793, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:53', '2021-05-28 12:31:53'),
(20665, 3040, 21794, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:56:48', '2021-03-16 10:56:48'),
(20666, 3040, 21794, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:31:59', '2021-05-28 12:31:59'),
(20667, 3040, 21795, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:57:00', '2021-03-16 10:57:00'),
(20668, 3040, 21795, NULL, '2021-06-04 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers.   For group contract please see group task. ', NULL, NULL, '2021-05-28 12:32:02', '2021-05-28 12:32:02'),
(20669, 3046, 21796, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:57:52', '2021-03-16 10:57:52'),
(20670, 3040, 21796, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:10:27', '2021-03-29 16:10:27'),
(20671, 3046, 21797, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:57:55', '2021-03-16 10:57:55'),
(20672, 3040, 21797, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:22:22', '2021-03-29 16:22:22'),
(20673, 3046, 21798, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:57:57', '2021-03-16 10:57:57'),
(20674, 3040, 21798, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:26:00', '2021-03-29 16:26:00'),
(20675, 3046, 21799, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:57:59', '2021-03-16 10:57:59'),
(20676, 3040, 21799, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:33:57', '2021-03-29 16:33:57'),
(20677, 3046, 21800, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:58:01', '2021-03-16 10:58:01'),
(20678, 3040, 21800, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:38:34', '2021-03-29 16:38:34'),
(20679, 3046, 21801, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:58:03', '2021-03-16 10:58:03'),
(20680, 3040, 21801, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:45:25', '2021-03-29 16:45:25'),
(20681, 3046, 21802, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 10:58:05', '2021-03-16 10:58:05'),
(20682, 3040, 21802, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group has a facility contract. No need to add individual provider.  Please see attachment ', NULL, NULL, '2021-03-29 16:47:49', '2021-03-29 16:47:49'),
(20683, 3040, 21803, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:01:04', '2021-03-16 11:01:04'),
(20684, 1006, 21803, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/06/2015 ', NULL, NULL, '2021-05-17 10:53:56', '2021-05-17 10:53:56'),
(20685, 3040, 21804, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:27', '2021-03-16 11:02:27'),
(20686, 1006, 21804, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/06/2015 ', NULL, NULL, '2021-05-17 11:29:17', '2021-05-17 11:29:17'),
(20687, 3046, 21805, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:33', '2021-03-16 11:02:33'),
(20688, 3040, 21805, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:49:11', '2021-03-29 15:49:11'),
(20689, 3040, 21805, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:37:01', '2021-04-16 07:37:01'),
(20690, 9057, 21805, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:16:39', '2021-05-26 09:16:39'),
(20691, 1006, 21805, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:03', '2021-06-15 16:45:03'),
(20692, 1006, 21805, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The welcome letter has been received and attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-06-17 13:59:42', '2021-06-17 13:59:42'),
(20693, 1006, 21806, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:38', '2021-03-16 11:02:38'),
(20694, 3040, 21806, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 GROUP NPI	1356906572 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-21 10:54:13', '2021-04-21 10:54:13'),
(20695, 3040, 21807, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:39', '2021-03-16 11:02:39'),
(20696, 1006, 21807, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/22/2020 ', NULL, NULL, '2021-05-17 11:25:47', '2021-05-17 11:25:47'),
(20697, 1006, 21808, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:40', '2021-03-16 11:02:40'),
(20698, 1019, 21808, NULL, '2021-04-13 00:00:00.000', 'Initiated', 'Initiated thru Palmetto GBA portal online ', NULL, NULL, '2021-04-06 16:51:00', '2021-04-06 16:51:00'),
(20699, 1019, 21808, NULL, '2021-04-20 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-04-13 13:28:04', '2021-04-13 13:28:04'),
(20700, 3046, 21809, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:41', '2021-03-16 11:02:41'),
(20701, 3040, 21809, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:47', '2021-03-29 15:48:47'),
(20702, 3040, 21809, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:35:01', '2021-04-16 07:35:01'),
(20703, 1006, 21809, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Leslie.Perez@healthsmart.com:  Sub: Fwd: Mary Gonzalez NPI 1952713083  \"Hello,  I need the following information on Mary Gonzalez NPI 1952713083.  Once, I\'ve obtained this information I will continue to credential this provider.    Copy of current board of specialty --   American Academy of Nurse Practitioners   Thank you,  Leslie Perez Credentialing Specialist 222 W. Las Colinas Blvd., Suite 500N Irving, TX 75039 PH:  214-574-1152   FAX 214-574-2368 Leslie.Perez@HealthSmart.com www.HealthSmart.com\"  We submitted the reply and attached the provider\'s AANP.', NULL, NULL, '2021-04-28 07:32:02', '2021-04-28 07:32:02'),
(20704, 9057, 21809, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:16:46', '2021-05-26 09:16:46'),
(20705, 1006, 21809, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:45:00', '2021-06-15 16:45:00'),
(20706, 1006, 21809, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The welcome letter has been received and attached for reference.   Eff: 06/01/2021', NULL, NULL, '2021-06-17 13:59:25', '2021-06-17 13:59:25'),
(20707, 1006, 21810, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:41', '2021-03-16 11:02:41'),
(20708, 3040, 21810, NULL, '2021-04-27 00:00:00.000', 'Approved', 'PROVIDER NAME	PRISCA HEFTI LIC PROVIDER PTAN	P02479250 PROVIDER NPI	1508133182 EFFECTIVE DATE	02/24/2020 END DATE	', NULL, NULL, '2021-04-20 14:11:49', '2021-04-20 14:11:49'),
(20709, 1006, 21811, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:43', '2021-03-16 11:02:43'),
(20710, 3040, 21811, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	BARBARA A HIGNITE PROVIDER PTAN	P02580825 PROVIDER NPI	1982617262 EFFECTIVE DATE	09/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-20 14:14:47', '2021-04-20 14:14:47'),
(20711, 1006, 21812, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:44', '2021-03-16 11:02:44'),
(20712, 3040, 21812, NULL, '2021-04-27 00:00:00.000', 'Approved', 'PROVIDER NAME	FAUZIA WALI KHAN M.D PROVIDER PTAN	P02479248 PROVIDER NPI	1699761965 EFFECTIVE DATE	08/05/2019 END DATE', NULL, NULL, '2021-04-20 14:10:58', '2021-04-20 14:10:58'),
(20713, 1006, 21813, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:46', '2021-03-16 11:02:46'),
(20714, 3040, 21813, NULL, '2021-04-27 00:00:00.000', 'Approved', 'PROVIDER NAME	LYNNETTA LOVELAND PROVIDER PTAN	Q00018358 PROVIDER NPI	1598163602 EFFECTIVE DATE	10/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-20 14:15:54', '2021-04-20 14:15:54'),
(20715, 1006, 21814, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:48', '2021-03-16 11:02:48'),
(20716, 3040, 21814, NULL, '2021-04-27 00:00:00.000', 'Approved', 'PROVIDER NAME	PEGGY PIONKE PROVIDER PTAN	P02479232 PROVIDER NPI	1699307322 EFFECTIVE DATE	01/21/2020 END DATE	', NULL, NULL, '2021-04-20 14:12:50', '2021-04-20 14:12:50'),
(20717, 1006, 21815, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:50', '2021-03-16 11:02:50'),
(20718, 3040, 21815, NULL, '2021-04-28 00:00:00.000', 'Approved', 'PROVIDER NAME	MAHREEN RASHID PMH PROVIDER PTAN	P02479242 PROVIDER NPI	1396393146 EFFECTIVE DATE	10/24/2019 END DATE', NULL, NULL, '2021-04-21 10:54:57', '2021-04-21 10:54:57'),
(20719, 3046, 21816, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:52', '2021-03-16 11:02:52');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(20720, 3040, 21816, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Health smart for our group Statcare Minor Emergency Clinic under the below mentioned locations.   Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 15:48:17', '2021-03-29 15:48:17'),
(20721, 3040, 21816, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email sent to: mdiprsupport@healthsmart.com  Subject: Enroll Providers || Statcare Minor Emergency Clinic || Francis, William Robert, Gonzalez, Mary C & Trevino, Rose Puentes || Health Smart ||  Greetings,   Please find the attached CAQH access form for the providers that were requested in your previous email.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-16 07:31:45', '2021-04-16 07:31:45'),
(20722, 9057, 21816, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to mdiprsupport@healthsmart.com Sub: Enrollment request status - RHC - Health Smart  Hello, We submitted a request for the enrollment of providers under the following group.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 2: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 3: Provider Name: Trevino, Rose Puentes Provider NPI# 1437174794  Kindly let us know what is the current status regarding our request as soon as possible.  Thanks  ', NULL, NULL, '2021-05-26 09:16:53', '2021-05-26 09:16:53'),
(20723, 9057, 21816, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We Received an email from mdiprsupport@healthsmart.com  They asked for the submission of form for this provider, now we have submitted it. Attached is reference', NULL, NULL, '2021-05-28 09:47:51', '2021-05-28 09:47:51'),
(20724, 1006, 21816, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status - RHC - HealthSmart  \"Hello,  I hope you\'re doing well, I needed to get an update regarding the enrollment and location update status for the following providers under our group, their info is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415 Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-15 16:44:57', '2021-06-15 16:44:57'),
(20725, 1006, 21816, NULL, '2021-06-24 00:00:00.000', 'Approved', 'William Francis - Eff: 01/01/2021 Ref# 2046862  Location addition has been completed, it has been attached for reference. ', NULL, NULL, '2021-06-17 13:56:31', '2021-06-17 13:56:31'),
(20726, 1006, 21817, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:52', '2021-03-16 11:02:52'),
(20727, 3040, 21817, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	CARLEE ROZELL NP PROVIDER PTAN	P02586446 PROVIDER NPI	1225645393 EFFECTIVE DATE	11/23/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-20 14:15:23', '2021-04-20 14:15:23'),
(20728, 1006, 21818, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:02:57', '2021-03-16 11:02:57'),
(20729, 3040, 21818, NULL, '2021-04-27 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JONATHAN SCHUBERT LCS PROVIDER PTAN	P02518084 PROVIDER NPI	1235755505 EFFECTIVE DATE	05/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-20 14:13:52', '2021-04-20 14:13:52'),
(20730, 3040, 21819, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:00', '2021-03-16 11:03:00'),
(20731, 1006, 21819, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 01/29/2020 ', NULL, NULL, '2021-05-17 10:56:31', '2021-05-17 10:56:31'),
(20732, 1006, 21820, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:04', '2021-03-16 11:03:04'),
(20733, 1019, 21820, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Initiated application thru portal ', NULL, NULL, '2021-04-02 14:08:47', '2021-04-02 14:08:47'),
(20734, 1019, 21820, NULL, '2021-04-15 00:00:00.000', 'Approved', 'PTAN has been active effective from 01/01/2021. see attachment for approval Also sent test email', NULL, NULL, '2021-04-08 13:25:19', '2021-04-08 13:25:19'),
(20735, 1006, 21821, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:10', '2021-03-16 11:03:10'),
(20736, 3040, 21821, NULL, '2021-04-27 00:00:00.000', 'Approved', 'PROVIDER NAME	KATIE TAWAKOL NP PROVIDER PTAN	P02479252 PROVIDER NPI	1609222116 EFFECTIVE DATE	01/12/2020 END DATE	', NULL, NULL, '2021-04-20 14:09:37', '2021-04-20 14:09:37'),
(20737, 1006, 21822, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:13', '2021-03-16 11:03:13'),
(20738, 3040, 21822, NULL, '2021-04-28 00:00:00.000', 'Approved', 'PROVIDER NAME	JENNIFER L ULLRICH PROVIDER PTAN	P02531593 PROVIDER NPI	1710489760 EFFECTIVE DATE	05/01/2020 END DATE	 GROUP NAME	SPECTRUM NEURO BEHAVIORAL CA GROUP PTAN	EA0358 BUSINESS STATE	MA EFFECTIVE DATE	08/05/2019 END DATE	', NULL, NULL, '2021-04-21 10:55:34', '2021-04-21 10:55:34'),
(20739, 3040, 21823, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:19', '2021-03-16 11:03:19'),
(20740, 1006, 21823, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 02/11/2020 ', NULL, NULL, '2021-05-17 11:25:16', '2021-05-17 11:25:16'),
(20741, 3040, 21824, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:03:53', '2021-03-16 11:03:53'),
(20742, 1006, 21824, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/01/2020 ', NULL, NULL, '2021-05-17 11:00:02', '2021-05-17 11:00:02'),
(20743, 3040, 21825, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:04:16', '2021-03-16 11:04:16'),
(20744, 1006, 21825, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/01/2020 ', NULL, NULL, '2021-05-17 11:23:05', '2021-05-17 11:23:05'),
(20745, 3040, 21826, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:04:34', '2021-03-16 11:04:34'),
(20746, 1006, 21826, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 03/19/2020 ', NULL, NULL, '2021-05-17 11:31:56', '2021-05-17 11:31:56'),
(20747, 3040, 21827, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:04:57', '2021-03-16 11:04:57'),
(20748, 1006, 21827, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 08/13/2018 ', NULL, NULL, '2021-05-17 11:27:36', '2021-05-17 11:27:36'),
(20749, 3040, 21828, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:05:15', '2021-03-16 11:05:15'),
(20750, 1006, 21828, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 05/01/2019  ', NULL, NULL, '2021-05-17 10:54:59', '2021-05-17 10:54:59'),
(20751, 3040, 21829, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:05:33', '2021-03-16 11:05:33'),
(20752, 1006, 21829, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 04/22/2017 ', NULL, NULL, '2021-05-17 11:36:22', '2021-05-17 11:36:22'),
(20753, 3040, 21830, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:05:45', '2021-03-16 11:05:45'),
(20754, 1006, 21830, NULL, '2021-05-24 00:00:00.000', 'Not Eligible', '\"As per Abdur Rauf, Sheena Nampimadon is no longer with them effective from 12/15/2020.\" ', NULL, NULL, '2021-05-17 11:40:32', '2021-05-17 11:40:32'),
(20755, 3040, 21831, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:06:04', '2021-03-16 11:06:04'),
(20756, 1006, 21831, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is approved with Medicaid, approval confirmation is attached for reference.   Eff: 02/07/2020 ', NULL, NULL, '2021-05-17 11:30:41', '2021-05-17 11:30:41'),
(20757, 3040, 21832, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:06:25', '2021-03-16 11:06:25'),
(20758, 3040, 21832, NULL, '2021-04-21 00:00:00.000', 'Initiated', 'Application Status Submitted		  PEP Ticket Number 17715367 ', NULL, NULL, '2021-04-14 08:07:19', '2021-04-14 08:07:19'),
(20759, 1006, 21832, NULL, '2021-05-18 00:00:00.000', 'Approved', 'The provider is approved in Medicaid, approval confirmation and location confirmation are attached for reference.  Eff: 01/01/2021 ', NULL, NULL, '2021-05-11 12:21:01', '2021-05-11 12:21:01'),
(20760, 3046, 21833, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:08:51', '2021-03-16 11:08:51'),
(20761, 1006, 21833, NULL, '2021-04-05 00:00:00.000', 'Approved', 'The Group has an Urgent Care Contract with Humana effective 02/17/2017. Emptoris Contract Number: 38183.  All Three Locations Added. ', NULL, NULL, '2021-03-29 16:14:50', '2021-03-29 16:14:50'),
(20762, 3046, 21834, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:49', '2021-03-16 11:10:49'),
(20763, 1006, 21834, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference. ', NULL, NULL, '2021-03-26 16:43:41', '2021-03-26 16:43:41'),
(20764, 3046, 21835, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:51', '2021-03-16 11:10:51'),
(20765, 1006, 21835, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:45:20', '2021-03-26 16:45:20'),
(20766, 3046, 21836, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:52', '2021-03-16 11:10:52'),
(20767, 1006, 21836, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:45:50', '2021-03-26 16:45:50'),
(20768, 3046, 21837, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:54', '2021-03-16 11:10:54'),
(20769, 1006, 21837, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:46:12', '2021-03-26 16:46:12'),
(20770, 3046, 21838, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:57', '2021-03-16 11:10:57'),
(20771, 1006, 21838, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:46:31', '2021-03-26 16:46:31'),
(20772, 3046, 21839, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:10:58', '2021-03-16 11:10:58'),
(20773, 1006, 21839, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:46:57', '2021-03-26 16:46:57'),
(20774, 3046, 21840, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:11:00', '2021-03-16 11:11:00'),
(20775, 1006, 21840, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:47:42', '2021-03-26 16:47:42'),
(20776, 3046, 21841, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:11:02', '2021-03-16 11:11:02'),
(20777, 1006, 21841, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:48:06', '2021-03-26 16:48:06'),
(20778, 3046, 21842, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:11:05', '2021-03-16 11:11:05'),
(20779, 1006, 21842, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:48:29', '2021-03-26 16:48:29'),
(20780, 3046, 21843, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:22:41', '2021-03-16 11:22:41'),
(20781, 1006, 21843, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Request submitted via TMHP website:  Enrollment Application Status  Application Status PEP Ticket Number Submitted		17675965 ', NULL, NULL, '2021-03-26 15:27:09', '2021-03-26 15:27:09'),
(20782, 1006, 21843, NULL, '2021-05-25 00:00:00.000', 'Approved', 'The provider has been enrolled in Medicaid, approval and location confirmation are attached: Eff: 01/01/2021 TPI# 372072404', NULL, NULL, '2021-05-18 11:51:52', '2021-05-18 11:51:52'),
(20783, 3046, 21844, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:40:32', '2021-03-16 11:40:32'),
(20784, 1005, 21844, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits has been reassigned to the group. ', NULL, NULL, '2021-03-25 14:34:41', '2021-03-25 14:34:41'),
(20785, 3046, 21856, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:46:47', '2021-03-16 11:46:47'),
(20786, 3040, 21856, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.  ', NULL, NULL, '2021-03-30 14:37:20', '2021-03-30 14:37:20'),
(20787, 3046, 21857, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:46:52', '2021-03-16 11:46:52'),
(20788, 3040, 21857, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.', NULL, NULL, '2021-03-30 14:40:05', '2021-03-30 14:40:05'),
(20789, 3046, 21858, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:46:54', '2021-03-16 11:46:54'),
(20790, 3040, 21858, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   ', NULL, NULL, '2021-03-30 14:43:21', '2021-03-30 14:43:21'),
(20791, 3046, 21859, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:46:56', '2021-03-16 11:46:56'),
(20792, 3040, 21859, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:46:28', '2021-03-30 14:46:28'),
(20793, 3046, 21860, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:46:58', '2021-03-16 11:46:58'),
(20794, 3040, 21860, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:48:54', '2021-03-30 14:48:54'),
(20795, 3046, 21861, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:47:00', '2021-03-16 11:47:00'),
(20796, 3040, 21861, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider. ', NULL, NULL, '2021-03-30 14:51:08', '2021-03-30 14:51:08'),
(20797, 3046, 21862, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:47:02', '2021-03-16 11:47:02'),
(20798, 3040, 21862, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.  ', NULL, NULL, '2021-03-30 15:01:21', '2021-03-30 15:01:21'),
(20799, 3046, 21863, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:47:04', '2021-03-16 11:47:04'),
(20800, 3040, 21863, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.', NULL, NULL, '2021-03-30 15:02:40', '2021-03-30 15:02:40'),
(20801, 3046, 21864, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 11:47:07', '2021-03-16 11:47:07'),
(20802, 3040, 21864, NULL, '2021-04-06 00:00:00.000', 'Approved', ' Group has ancillary contract. No need to add the individual provider.    ', NULL, NULL, '2021-03-30 15:04:58', '2021-03-30 15:04:58'),
(20803, 1006, 21865, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:03', '2021-03-16 12:04:03'),
(20804, 1019, 21865, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:59:19', '2021-04-21 13:59:19'),
(20805, 1019, 21865, NULL, '2021-05-03 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 11:39:02', '2021-04-26 11:39:02'),
(20806, 1019, 21865, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.  ', NULL, NULL, '2021-04-28 10:28:42', '2021-04-28 10:28:42'),
(20807, 1019, 21865, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:24:25', '2021-05-20 11:24:25'),
(20808, 1019, 21865, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:54', '2021-06-16 08:01:54'),
(20809, 19067, 21865, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"  ', NULL, NULL, '2021-12-29 12:06:14', '2021-12-29 12:06:14'),
(20810, 19067, 21865, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:15:14', '2022-01-10 14:15:14'),
(20811, 19067, 21865, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:30', '2022-01-11 09:36:30'),
(20812, 19067, 21865, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:17:31', '2022-02-11 11:17:31'),
(20813, 19067, 21865, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:37', '2022-02-11 11:23:37'),
(20814, 19067, 21865, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:45', '2022-03-17 09:49:45'),
(20815, 19067, 21865, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:58', '2022-03-17 10:34:58'),
(20816, 19067, 21865, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:53', '2022-03-17 10:36:53'),
(20817, 19067, 21865, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:59:01', '2022-03-17 13:59:01'),
(20818, 19067, 21865, NULL, '2022-03-28 00:00:00.000', 'In Process', 'Email sent to: asantulli@humana.com, JMcGrew3@humana.com  Subject: Re: Enrollment Request || SNBCARE || TMS || Tricare ||   Good Morning!  Hope this email finds you well. Any updates on the request mentioned below? Kindly make an update on it as it is Time Sensitive.  Thanks, Hammad ', NULL, NULL, '2022-03-21 10:34:23', '2022-03-21 10:34:23'),
(20819, 1006, 21866, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:04', '2021-03-16 12:04:04'),
(20820, 1019, 21866, NULL, '2021-04-29 00:00:00.000', 'New/Not Initiated', 'Waiting to get enroll with Framingham location, once enrollment is completed with Framingham location, then will sent the LOI for Raynham Location.', NULL, NULL, '2021-04-22 07:36:26', '2021-04-22 07:36:26'),
(20821, 1019, 21866, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting to get enroll with Framingham location, once enrollment is completed with Framingham location, then will sent the LOI for Raynham Location. ', NULL, NULL, '2021-04-22 08:41:51', '2021-04-22 08:41:51'),
(20822, 1019, 21866, NULL, '2021-05-03 00:00:00.000', 'New/Not Initiated', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:19:42', '2021-04-26 15:19:42'),
(20823, 1019, 21866, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:39:51', '2021-04-28 10:39:51'),
(20824, 1019, 21866, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:20:33', '2021-05-20 11:20:33'),
(20825, 1019, 21866, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:48:31', '2021-05-31 10:48:31'),
(20826, 1019, 21866, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:47', '2021-06-16 08:01:47'),
(20827, 1019, 21866, NULL, '2021-11-01 00:00:00.000', 'Not Eligible', 'Provider will no longer be working with SNBCare.', NULL, NULL, '2021-10-25 10:45:14', '2021-10-25 10:45:14'),
(20828, 1006, 21867, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:08', '2021-03-16 12:04:08'),
(20829, 1019, 21867, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:43:10', '2021-04-21 13:43:10'),
(20830, 1019, 21867, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:57:03', '2021-04-26 09:57:03'),
(20831, 1019, 21867, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:18:41', '2021-04-26 15:18:41'),
(20832, 1019, 21867, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:39:37', '2021-04-28 10:39:37');
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
(20833, 1019, 21867, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:24:09', '2021-05-20 11:24:09'),
(20834, 1019, 21867, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:58:23', '2021-05-31 10:58:23'),
(20835, 1019, 21867, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:41', '2021-06-16 08:01:41'),
(20836, 19067, 21867, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:23', '2021-12-16 14:10:23'),
(20837, 19067, 21867, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:13', '2021-12-29 12:07:13'),
(20838, 19067, 21867, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:15:09', '2022-01-10 14:15:09'),
(20839, 19067, 21867, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:38', '2022-01-11 09:36:38'),
(20840, 19067, 21867, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:54', '2022-01-11 10:47:54'),
(20841, 19067, 21867, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:17:17', '2022-02-11 11:17:17'),
(20842, 19067, 21867, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:30', '2022-02-11 11:23:30'),
(20843, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:40', '2022-03-17 09:49:40'),
(20844, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:53', '2022-03-17 10:34:53'),
(20845, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:48', '2022-03-17 10:36:48'),
(20846, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:54', '2022-03-17 13:58:54'),
(20847, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/03/2020. See attachment for location confirmation.', NULL, NULL, '2022-03-17 17:49:31', '2022-03-17 17:49:31'),
(20848, 19067, 21867, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Attachment.', NULL, NULL, '2022-03-17 17:49:44', '2022-03-17 17:49:44'),
(20849, 1006, 21868, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:11', '2021-03-16 12:04:11'),
(20850, 1019, 21868, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:54:32', '2021-04-21 13:54:32'),
(20851, 1019, 21868, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:59:21', '2021-04-26 09:59:21'),
(20852, 1019, 21868, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:17:08', '2021-04-26 15:17:08'),
(20853, 1019, 21868, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:39:26', '2021-04-28 10:39:26'),
(20854, 1019, 21868, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:23:17', '2021-05-20 11:23:17'),
(20855, 1019, 21868, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:53:57', '2021-05-31 10:53:57'),
(20856, 1019, 21868, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:34', '2021-06-16 08:01:34'),
(20857, 19067, 21868, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:29', '2021-12-16 14:10:29'),
(20858, 19067, 21868, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:18', '2021-12-29 12:07:18'),
(20859, 19067, 21868, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:41', '2022-01-10 14:14:41'),
(20860, 19067, 21868, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:51', '2022-01-11 09:36:51'),
(20861, 19067, 21868, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:49', '2022-01-11 10:47:49'),
(20862, 19067, 21868, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:40', '2022-02-11 11:16:40'),
(20863, 19067, 21868, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:26', '2022-02-11 11:23:26'),
(20864, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:34', '2022-03-17 09:49:34'),
(20865, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:47', '2022-03-17 10:34:47'),
(20866, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:44', '2022-03-17 10:36:44'),
(20867, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:46', '2022-03-17 13:58:46'),
(20868, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 10/01/2020. See attachment of location confirmation. ', NULL, NULL, '2022-03-17 17:44:49', '2022-03-17 17:44:49'),
(20869, 19067, 21868, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Attachment.', NULL, NULL, '2022-03-17 17:46:16', '2022-03-17 17:46:16'),
(20870, 1006, 21869, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:13', '2021-03-16 12:04:13'),
(20871, 1019, 21869, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:44:23', '2021-04-21 13:44:23'),
(20872, 1019, 21869, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:57:45', '2021-04-26 09:57:45'),
(20873, 1019, 21869, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:16:07', '2021-04-26 15:16:07'),
(20874, 1019, 21869, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:39:10', '2021-04-28 10:39:10'),
(20875, 1019, 21869, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:23:03', '2021-05-20 11:23:03');
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
(20876, 1019, 21869, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:57:35', '2021-05-31 10:57:35'),
(20877, 1019, 21869, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:21', '2021-06-16 08:01:21'),
(20878, 19067, 21869, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:42', '2021-12-16 14:10:42'),
(20879, 19067, 21869, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:23', '2021-12-29 12:07:23'),
(20880, 19067, 21869, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:36', '2022-01-10 14:14:36'),
(20881, 19067, 21869, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:36:56', '2022-01-11 09:36:56'),
(20882, 19067, 21869, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:28', '2022-01-11 10:47:28'),
(20883, 19067, 21869, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:17:24', '2022-02-11 11:17:24'),
(20884, 19067, 21869, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:20', '2022-02-11 11:23:20'),
(20885, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:28', '2022-03-17 09:49:28'),
(20886, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:42', '2022-03-17 10:34:42'),
(20887, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:38', '2022-03-17 10:36:38'),
(20888, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:38', '2022-03-17 13:58:38'),
(20889, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/03/2020. See attachment of location confirmation. ', NULL, NULL, '2022-03-17 17:32:46', '2022-03-17 17:32:46'),
(20890, 19067, 21869, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Attachment.', NULL, NULL, '2022-03-17 17:33:07', '2022-03-17 17:33:07'),
(20891, 1006, 21870, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:14', '2021-03-16 12:04:14'),
(20892, 1019, 21870, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:55:21', '2021-04-21 13:55:21'),
(20893, 1019, 21870, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 10:00:44', '2021-04-26 10:00:44'),
(20894, 1019, 21870, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:15:31', '2021-04-26 15:15:31'),
(20895, 1019, 21870, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:38:56', '2021-04-28 10:38:56'),
(20896, 1019, 21870, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:21:18', '2021-05-20 11:21:18'),
(20897, 1019, 21870, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:51:27', '2021-05-31 10:51:27'),
(20898, 1019, 21870, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:13', '2021-06-16 08:01:13'),
(20899, 19067, 21870, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:50', '2021-12-16 14:10:50'),
(20900, 19067, 21870, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:30', '2021-12-29 12:07:30'),
(20901, 19067, 21870, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:31', '2022-01-10 14:14:31'),
(20902, 19067, 21870, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:01', '2022-01-11 09:37:01'),
(20903, 19067, 21870, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:18', '2022-01-11 10:47:18'),
(20904, 19067, 21870, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:47', '2022-02-11 11:16:47'),
(20905, 19067, 21870, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:15', '2022-02-11 11:23:15'),
(20906, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:23', '2022-03-17 09:49:23'),
(20907, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:29', '2022-03-17 10:34:29'),
(20908, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:34', '2022-03-17 10:36:34'),
(20909, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:29', '2022-03-17 13:58:29'),
(20910, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Attached is the roster received from Tricare', NULL, NULL, '2022-03-17 17:22:06', '2022-03-17 17:22:06'),
(20911, 19067, 21870, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/22/2021. See attachment of location confirmation. ', NULL, NULL, '2022-03-17 17:24:24', '2022-03-17 17:24:24'),
(20912, 1006, 21871, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:16', '2021-03-16 12:04:16'),
(20913, 3040, 21871, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'Request could not be completed due to provider specialty of LCSW, but tricare recommended to submit claims under different providers.  ', NULL, NULL, '2021-04-21 08:30:30', '2021-04-21 08:30:30'),
(20914, 1019, 21871, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for. Let me know if you need anything else.   Regards, Alex', NULL, NULL, '2021-04-26 11:40:41', '2021-04-26 11:40:41'),
(20915, 1019, 21871, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:38:39', '2021-04-28 10:38:39'),
(20916, 1006, 21872, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:18', '2021-03-16 12:04:18'),
(20917, 1019, 21872, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:39:34', '2021-04-21 13:39:34'),
(20918, 1019, 21872, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:56:36', '2021-04-26 09:56:36'),
(20919, 1019, 21872, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:13:57', '2021-04-26 15:13:57'),
(20920, 1019, 21872, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:38:26', '2021-04-28 10:38:26'),
(20921, 1019, 21872, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:21:59', '2021-05-20 11:21:59'),
(20922, 1019, 21872, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:53:03', '2021-05-31 10:53:03');
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
(20923, 1019, 21872, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:01:04', '2021-06-16 08:01:04'),
(20924, 19067, 21872, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:10:56', '2021-12-16 14:10:56'),
(20925, 19067, 21872, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:37', '2021-12-29 12:07:37'),
(20926, 19067, 21872, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:24', '2022-01-10 14:14:24'),
(20927, 19067, 21872, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:07', '2022-01-11 09:37:07'),
(20928, 19067, 21872, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:14', '2022-01-11 10:47:14'),
(20929, 19067, 21872, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:17:10', '2022-02-11 11:17:10'),
(20930, 19067, 21872, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:11', '2022-02-11 11:23:11'),
(20931, 19067, 21872, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:17', '2022-03-17 09:49:17'),
(20932, 19067, 21872, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:24', '2022-03-17 10:34:24'),
(20933, 19067, 21872, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:30', '2022-03-17 10:36:30'),
(20934, 19067, 21872, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:23', '2022-03-17 13:58:23'),
(20935, 19067, 21872, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/03/2020. See attachment of location confirmation. ', NULL, NULL, '2022-03-17 17:18:37', '2022-03-17 17:18:37'),
(20936, 1006, 21873, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:20', '2021-03-16 12:04:20'),
(20937, 1019, 21873, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:55:04', '2021-04-21 13:55:04'),
(20938, 1019, 21873, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:59:46', '2021-04-26 09:59:46'),
(20939, 1019, 21873, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:13:34', '2021-04-26 15:13:34'),
(20940, 1019, 21873, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:38:06', '2021-04-28 10:38:06'),
(20941, 1019, 21873, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:23:43', '2021-05-20 11:23:43'),
(20942, 1019, 21873, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:55:22', '2021-05-31 10:55:22'),
(20943, 1019, 21873, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:56', '2021-06-16 08:00:56'),
(20944, 1019, 21873, NULL, '2021-11-16 00:00:00.000', 'Not Eligible', 'Provider will no longer with SNBCARE.', NULL, NULL, '2021-11-09 10:33:13', '2021-11-09 10:33:13'),
(20945, 1006, 21874, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:22', '2021-03-16 12:04:22'),
(20946, 1019, 21874, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:47:11', '2021-04-21 13:47:11'),
(20947, 1019, 21874, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:58:42', '2021-04-26 09:58:42'),
(20948, 1019, 21874, NULL, '2021-05-03 00:00:00.000', 'Initiated', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 11:43:33', '2021-04-26 11:43:33'),
(20949, 1019, 21874, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:37:47', '2021-04-28 10:37:47'),
(20950, 1019, 21874, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:23:29', '2021-05-20 11:23:29'),
(20951, 1019, 21874, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:54:51', '2021-05-31 10:54:51'),
(20952, 1019, 21874, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:48', '2021-06-16 08:00:48'),
(20953, 19067, 21874, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:11:01', '2021-12-16 14:11:01'),
(20954, 19067, 21874, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:07:42', '2021-12-29 12:07:42'),
(20955, 19067, 21874, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:18', '2022-01-10 14:14:18'),
(20956, 19067, 21874, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:12', '2022-01-11 09:37:12'),
(20957, 19067, 21874, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:09', '2022-01-11 10:47:09'),
(20958, 19067, 21874, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:16:35', '2022-02-11 11:16:35'),
(20959, 19067, 21874, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:06', '2022-02-11 11:23:06'),
(20960, 19067, 21874, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:11', '2022-03-17 09:49:11'),
(20961, 19067, 21874, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:18', '2022-03-17 10:34:18'),
(20962, 19067, 21874, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:26', '2022-03-17 10:36:26'),
(20963, 19067, 21874, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:58:16', '2022-03-17 13:58:16'),
(20964, 19067, 21874, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 04/28/2021. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 16:16:58', '2022-03-17 16:16:58'),
(20965, 1006, 21875, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:23', '2021-03-16 12:04:23'),
(20966, 1019, 21875, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting to get enroll with Framingham location, once enrollment is completed with Framingham location, then will sent the LOI for Raynham Location.', NULL, NULL, '2021-04-02 15:01:38', '2021-04-02 15:01:38'),
(20967, 1019, 21875, NULL, '2021-04-29 00:00:00.000', 'On Hold', 'Waiting to get enroll with Framingham location, once enrollment is completed with Framingham location, then will sent the LOI for Raynham Location. ', NULL, NULL, '2021-04-22 08:42:49', '2021-04-22 08:42:49'),
(20968, 19067, 21875, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Eff date: 04/28/2021. See attachment for location confirmation. ', NULL, NULL, '2022-03-17 17:55:04', '2022-03-17 17:55:04'),
(20969, 1006, 21876, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:25', '2021-03-16 12:04:25');
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
(20970, 1019, 21876, NULL, '2021-04-28 00:00:00.000', 'Initiated', 'Sent the following email to: asantulli@humana.com SUB: Location Addition || Group & Providers || SNBCARE || Tricare   Hello. We need to add a new location under the group and link the following providers with that new location. Mentioned is the list of Providers which we need to add under the following locations for our group in Tricare.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Katie Tawakol NPI: 1609222116 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti NPI: 1508133182  Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan NPI: 1699761965 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Peggy Pionke NPI: 1699307322 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jennifer L Ullrich NPI: 1710489760 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Barbara Hignite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Regards, Alex G. ', NULL, NULL, '2021-04-21 13:38:31', '2021-04-21 13:38:31'),
(20971, 1019, 21876, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Received the following message from asantulli@humana.com  Thank you for your email. The location, 100 New State Highway, Raynham MA 02767 is not currently listed under your TIN. Please complete the attached New Location Form and email back to me to have this location added and the practitioners linked.  In addition to the above, the practitioners , Peggy Pionke, Jennifer Ullrich, Jonathan Schubert, Rodesia Edmundson, and Kerry Smith are not credentialed and require credentialing to be network to your TIN. For credentialing, please email me a printed copy of the CAQH with a copy of the practitioner’s license, DEA, & Malpractice Certificate reflecting the practitioner’s name and coverage for each one. Please allow a minimum of one week for any updates made to be visible in your Portal.  Thank you, Anne Santulli  Senior Consumer Operations Professional TRICARE Community Liaison 2 Field Operations, Humana Military Servicing provider relations for Maine, New Hampshire, Massachusetts T 502.318.5146 F 603.371.2404 asantulli@humana.com Find us on the web at www.humanamilitary.com', NULL, NULL, '2021-04-26 09:55:25', '2021-04-26 09:55:25'),
(20972, 1019, 21876, NULL, '2021-05-03 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 15:12:12', '2021-04-26 15:12:12'),
(20973, 1019, 21876, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners.', NULL, NULL, '2021-04-28 10:37:17', '2021-04-28 10:37:17'),
(20974, 1019, 21876, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-05-20 11:23:57', '2021-05-20 11:23:57'),
(20975, 1019, 21876, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Received the following email from ASantulli@humana.com The status for each practitioner is below, adjacent to each name.  Individual Providers:  Melody L\'Etoile                     Credentialing in progress, not yet approved, locations confirmed NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons                       Credentialing in progress, not yet approved, locations confirmed NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson                         Credentialing in progress, not yet approved, locations confirmed NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith                                        Credentialing in progress, not yet approved, locations confirmed NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland                           Credentialing in progress, not yet approved, locations confirmed NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid                    Credentialed/linked 4/3/2020, locations confirmed NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite                                 Credentialing in progress, not yet approved, locations confirmed NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert                            Credentialing in progress, not yet approved, locations confirmed  NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell                                      Credentialing in progress, not yet approved, location confirmed NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol                       Credentialed 4/28/2020, Waiting to add location NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan                 Credentialed 5/19/2020, added to locations 4/20/2020 & Waiting to add to Raynham Loc. NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.            Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti                            Credentialed 5/5/2020, added to location 5/4/2021 NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva                              Not recognized by name or NPI, not certified/credentialed/linked NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere                       Not credentialed, pls send DOB, SSN & CAQH number for credentialing NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-31 10:56:10', '2021-05-31 10:56:10'),
(20976, 1019, 21876, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to ASantulli@humana.com SUB: Enrollment Query || Group & Providers || SNBCARE || Tricare  Hello Anne, Hope you are doing good, I need the enrollment status for the following providers. I will really appreciate your help with this.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual Providers:  Melody L\'Etoile NPI: 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI:1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Lynnetta Loveland NPI: 1598163602 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Mahreen Rashid NPI: 1396393146 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.   Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896.  Barbara Hignite NPI: 1982617262 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Jonathan Schubert NPI: 1235755505 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Carlee Rozell NPI: 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Katie Tawakol NPI: 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Fauzia Wali Khan NPI: 1699761965 Primary Location: 63 Eddie Dowling Highway, Suite 9, Framingham, MA, 02896. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Prisca Hefti NPI: 1508133182  Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Erin Oliva NPI: 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Regards,', NULL, NULL, '2021-06-16 08:00:42', '2021-06-16 08:00:42'),
(20977, 19067, 21876, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hello,  Hope you are having a productive day and you are staying healthy,  I would like to know the enrollment status of the following providers with mentioned locations.  If any Provider is enrolled then provide us with the Effective date and Welcome letter for each provider that would be very helpful for us.  Group Name	Spectrum Neuro Behavioral Care LLC Tax ID	83-4482753 Group NPI	1356906572 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Filoteo-Nichols, Dina	1770021099	61 Lincoln St., Suite 203, Framingham, MA 01702 Halterman, Helena	1801473749	100 NEW STATE HWY RAYNHAM, MA 02767-5423 Halterman, Helena	1801473749	61 Lincoln St., Suite 203, Framingham, MA 01702 Hartman, Jessica	1326665472	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Oliva, Erin	1407349632	63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322  Kindly reply to me promptly.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-16 14:11:19', '2021-12-16 14:11:19'),
(20978, 19067, 21876, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Secure email received from: ASantulli@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   The status for each practitioner is listed below, adjacent to each name.  Group Name	Spectrum Neuro Behavioral Care LLC	 Tax ID	83-4482753	 Group NPI	1356906572	 		 Provider Name	NPI	Location Filoteo-Nichols, Dina	1770021099	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Filoteo-Nichols, Dina	1770021099	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Certified 11/6/2021, not credentialed\" Halterman, Helena	1801473749	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Certified 11/6/2021, not credentialed\" Hartman, Jessica	1356906572	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Not recognized, not yet certified/credentialed\" Hartman, Jessica	1356906572	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Not recognized, not yet certified/credentialed\" Hefti, Prisca	1508133182	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Hignite, Barbara	1982617262	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/5/2020, linked 5/4/2021\" Khan, Fauzia	1699761965	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Loveland, Lynnetta	1598163602	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/19/2018, linked 4/22/2021\" Rashid, Mahreen	1396393146	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\" Schubert, Jonathan	1235755505	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 7/19/2021\" Smith, Kerry	1275083230	\"61 Lincoln St., Suite 203, Framingham, MA 01702 Credentialed 9/21/2021\" Souliere, Justin	1710576004	\"63 Eddie Dowling Hwy, Suite 8 North Smithfield, RI 02896-7322 Not recognized, not yet certified/credentialed\" Tawakol, Katie	1609222116	\"100 NEW STATE HWY RAYNHAM, MA 02767-5423 Credentialed 11/2/2021\"', NULL, NULL, '2021-12-29 12:08:04', '2021-12-29 12:08:04'),
(20979, 19067, 21876, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com, asantulli@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Greetings!  How can I enroll the providers which are not yet credentialed?  Kindly respond promptly.  Thanks,  Hammad Ahmed. ', NULL, NULL, '2022-01-10 14:14:10', '2022-01-10 14:14:10'),
(20980, 19067, 21876, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     I’ll just need their CAQH numbers; their CAQH info should be newly attested and up to date, and Humana Military will need access. For Souliere, I’ll also need the attached form; his current status means I have to submit for another department to affiliate him.     Thanks!             Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-01-11 09:37:18', '2022-01-11 09:37:18'),
(20981, 19067, 21876, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Good Morning Chuck!  Hope this email finds you well.  Kindly see the attached forms for the provider as per your request.  Don\'t hesitate to reach me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-11 10:47:04', '2022-01-11 10:47:04'),
(20982, 19067, 21876, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi, Hammad!     OK, except for Souliere, everybody here is already attached to these sites except for 63 Eddy Dowling Suite 8, which doesn’t exist for us. We do have Suite NINE; is this a typo on our end, or do we need to build Suite 8?     Thanks!   Chuck McGrew  Tricare Community Liaison II  Servicing provider relations matters in the following areas:  RI / CT / Western MA     Humana Military     T 502-313-9524  F 806-517-2809  jmcgrew3@humana.com     www.humanamilitary.com', NULL, NULL, '2022-02-11 11:17:03', '2022-02-11 11:17:03'),
(20983, 19067, 21876, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||  Hello!  The correct address is 63 Eddie Dowling Hwy, Suite 8. Kindly make an update on it.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 11:23:01', '2022-02-11 11:23:01'),
(20984, 19067, 21876, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: JMcGrew3@humana.com  Subject: Re: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Hi Chuck!  Has the address been updated for all the providers? Kindly make an update on it.  Thanks,', NULL, NULL, '2022-03-17 09:49:05', '2022-03-17 09:49:05'),
(20985, 19067, 21876, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Re: Secured:  RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||   Oh, yeah. That sort of update isn’t provider-by-provider, it applies to the site itself, to which the practitioners are attached. A change like that affects all affiliated providers.', NULL, NULL, '2022-03-17 10:34:12', '2022-03-17 10:34:12'),
(20986, 19067, 21876, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email sent to: jmcgrew3@humana.com  Subject: Re: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi John,  Can you please confirm me that all the providers are in-network with Tricare and can you send me the welcome kit and effective date for all the providers. It will be of very help.  Thanks, Hammad Ahmed', NULL, NULL, '2022-03-17 10:36:21', '2022-03-17 10:36:21'),
(20987, 19067, 21876, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Secure email received from: JMcGrew3@humana.com  Subject: Secured: RE: Secured: RE: Enrollment Status || SNBCARE || Group & Providers || Tricare ||    Hi again!     We don’t send out any kind of welcome kit, I’m afraid. Confirmation letters are, in theory, sent when a provider certifies, and then again if they credential as in-network, but that’s it. I’ve attached a roster of all providers we have attached to Spectrum’s TIN; we’re unable to generate one with effective dates, but that information is available on the Portal. It’s totally irrelevant for claims, though; no matter what effective date a provider has on their end, the claim will process over here.', NULL, NULL, '2022-03-17 13:56:27', '2022-03-17 13:56:27'),
(20988, 19067, 21876, NULL, '2022-03-24 00:00:00.000', 'Approved', 'Effective date: 03/20/2020. See attachment of Provider Portal with all locations.', NULL, NULL, '2022-03-17 14:59:52', '2022-03-17 14:59:52'),
(20989, 1006, 21877, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:04:26', '2021-03-16 12:04:26'),
(20990, 3040, 21877, NULL, '2021-04-28 00:00:00.000', 'On Hold', 'Tricare is unable to certify or credential LCSW providers. ', NULL, NULL, '2021-04-21 08:46:23', '2021-04-21 08:46:23'),
(20991, 3040, 21877, NULL, '2021-04-28 00:00:00.000', 'Not Eligible', 'Tricare is unable to certify or credential LCSW providers. ', NULL, NULL, '2021-04-21 08:46:45', '2021-04-21 08:46:45'),
(20992, 1019, 21877, NULL, '2021-05-03 00:00:00.000', 'Not Eligible', 'Sent the following email to ASantulli@humana.com Hello Anne, Hope you are doing good, as per your request attached is the Location addition form, with the list of practitioners need to be linked under this address. Also we have attached the printed CAQH form and document for credentialing of the providers you requested for.Let me know if you need anything else.  Regards, Alex', NULL, NULL, '2021-04-26 11:42:25', '2021-04-26 11:42:25'),
(20993, 1019, 21877, NULL, '2021-05-05 00:00:00.000', 'Not Eligible', 'Received the following email from ASantulli@humana.com  Thank you, the documents have been received and loaded for processing. The New Location has been requested and credentialing has been requested for the practitioners. ', NULL, NULL, '2021-04-28 10:36:49', '2021-04-28 10:36:49'),
(20994, 3040, 21878, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:07:01', '2021-03-16 12:07:01'),
(20995, 1006, 21878, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 396951 Eff: 01/06/2015', NULL, NULL, '2021-05-17 10:14:43', '2021-05-17 10:14:43'),
(20996, 3040, 21879, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:07:46', '2021-03-16 12:07:46'),
(20997, 1006, 21879, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 396952ZM1S Eff: 01/06/2015', NULL, NULL, '2021-05-17 10:15:27', '2021-05-17 10:15:27'),
(20998, 3040, 21880, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:08:05', '2021-03-16 12:08:05'),
(20999, 1006, 21880, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 930809 Eff: 01/22/2020 ', NULL, NULL, '2021-05-17 10:16:06', '2021-05-17 10:16:06'),
(21000, 3040, 21881, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:08:50', '2021-03-16 12:08:50'),
(21001, 1006, 21881, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 544115ZM1S Eff: 10/30/2016 ', NULL, NULL, '2021-05-17 10:16:51', '2021-05-17 10:16:51'),
(21002, 3040, 21882, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:09:10', '2021-03-16 12:09:10'),
(21003, 1006, 21882, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 719085 Eff: 08/13/2018 ', NULL, NULL, '2021-05-17 10:17:25', '2021-05-17 10:17:25'),
(21004, 3040, 21883, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:09:29', '2021-03-16 12:09:29'),
(21005, 1006, 21883, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 829002 Eff: 05/01/2019 ', NULL, NULL, '2021-05-17 10:17:56', '2021-05-17 10:17:56'),
(21006, 3040, 21884, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:09:49', '2021-03-16 12:09:49'),
(21007, 1006, 21884, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with Medicare, approval confirmation is attached.  Provider ID# 573349ZM1S Eff: 04/22/2017 ', NULL, NULL, '2021-05-17 10:18:35', '2021-05-17 10:18:35'),
(21008, 3040, 21885, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:11:23', '2021-03-16 12:11:23'),
(21009, 1006, 21885, NULL, '2021-05-24 00:00:00.000', 'Not Eligible', '\"As per Abdur Rauf, Sheena Nampimadon is no longer with them effective from 12/15/2020.\" ', NULL, NULL, '2021-05-17 10:13:38', '2021-05-17 10:13:38'),
(21010, 3040, 21886, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:12:07', '2021-03-16 12:12:07'),
(21011, 3040, 21886, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:06', '2021-05-28 14:13:06'),
(21012, 3040, 21886, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:37', '2021-06-17 09:07:37'),
(21013, 3040, 21886, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:59', '2021-07-06 09:22:59'),
(21014, 3040, 21886, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-28 12:00:36', '2021-07-28 12:00:36'),
(21015, 3040, 21886, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:13:19', '2021-08-18 15:13:19'),
(21016, 10057, 21886, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:51:29', '2021-10-08 11:51:29'),
(21017, 10057, 21886, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:49', '2021-11-19 18:13:49'),
(21018, 10057, 21886, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:26:17', '2021-12-01 13:26:17'),
(21019, 10057, 21886, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 11:03:15', '2021-12-08 11:03:15'),
(21020, 10057, 21886, NULL, '2021-12-21 00:00:00.000', 'In Process', '', NULL, NULL, '2021-12-14 11:38:51', '2021-12-14 11:38:51'),
(21021, 10057, 21886, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:06:39', '2021-12-21 11:06:39'),
(21022, 10057, 21886, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:55', '2021-12-28 15:06:55'),
(21023, 20067, 21886, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:17:17', '2022-01-12 12:17:17'),
(21024, 20067, 21886, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:41:24', '2022-01-12 12:41:24'),
(21025, 20067, 21886, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:43:34', '2022-01-12 12:43:34'),
(21026, 20067, 21886, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Hope this email finds you in good spirits. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 Jeny John	1073019493 Brittany Brown	1275163537  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:57:55', '2022-01-20 10:57:55'),
(21027, 20067, 21886, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the updates below for each provider.     Jeny John -  Please allow a few more weeks for the credentialing application to process.   Once approved the request will be sent for loading in the billing system.     There  is no request on file for the remaining providers under the below TIN.    Please submit a contract request form for both providers if you haven’t already done so.  Please remember to submit an updated W9 with contract request forms and send to MHTContractrequest@Molinahealthcare.com.     Thank You,', NULL, NULL, '2022-01-28 15:26:14', '2022-01-28 15:26:14'),
(21028, 20067, 21886, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Thanks for the update kindly see the attached contract request for both providers.  Thank you, Syed Ahad', NULL, NULL, '2022-02-16 15:19:16', '2022-02-16 15:19:16'),
(21029, 20067, 21886, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening!  Hope this email finds you well. Can you please send me the Group Agreement for Longpoint Medical Center? Tax ID: 76-0612416 Group NPI: 1770763815  Waiting for your Early response. Thank you, Syed.', NULL, NULL, '2022-03-14 16:39:02', '2022-03-14 16:39:02'),
(21030, 20067, 21886, NULL, '2022-03-28 00:00:00.000', 'Approved', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Group Agreement || Longpoint Medical Center || Group || Molina Health ||  Good Afternoon,    Please see the attached contract.    Thank You,   Kindly see the attachments', NULL, NULL, '2022-03-21 16:38:35', '2022-03-21 16:38:35'),
(21031, 3040, 21887, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:12:22', '2021-03-16 12:12:22'),
(21032, 3040, 21887, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:09', '2021-05-28 14:13:09');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(21033, 3040, 21887, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:34', '2021-06-17 09:07:34'),
(21034, 3040, 21887, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:59', '2021-07-06 09:22:59'),
(21035, 3040, 21887, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-28 12:00:38', '2021-07-28 12:00:38'),
(21036, 11056, 21887, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:26:02', '2021-08-11 09:26:02'),
(21037, 3040, 21887, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Email rcvd from: Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179917  Good Morning,  Thank you for submitting the roster.  The request to add the below providers under all locations was previously submitted 7/6/21.   The request is complete all of the providers listed below have been added under all 3 locations  effective 7/15/21.   Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  ', NULL, NULL, '2021-08-17 16:53:39', '2021-08-17 16:53:39'),
(21038, 3040, 21888, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:12:39', '2021-03-16 12:12:39'),
(21039, 3040, 21888, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:11', '2021-05-28 14:13:11'),
(21040, 3040, 21888, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:31', '2021-06-17 09:07:31'),
(21041, 3040, 21888, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:58', '2021-07-06 09:22:58'),
(21042, 3040, 21888, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:24', '2021-07-26 15:03:24'),
(21043, 11056, 21888, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Odette Kourouma – The request has been sent to credentialing for processing.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:07:21', '2021-08-11 09:07:21'),
(21044, 11056, 21888, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Odette Kourouma – The request has been sent to credentialing for processing.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:07:21', '2021-08-11 09:07:21'),
(21045, 3040, 21888, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:08', '2021-08-18 15:07:08'),
(21046, 10057, 21888, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:51:12', '2021-10-08 11:51:12'),
(21047, 10057, 21888, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:58:06', '2021-11-15 10:58:06'),
(21048, 3040, 21889, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:12:56', '2021-03-16 12:12:56'),
(21049, 3040, 21889, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:14', '2021-05-28 14:13:14'),
(21050, 3040, 21889, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:29', '2021-06-17 09:07:29'),
(21051, 3040, 21889, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:57', '2021-07-06 09:22:57'),
(21052, 3040, 21889, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:50', '2021-07-26 15:03:50'),
(21053, 11056, 21889, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:20:31', '2021-08-11 09:20:31'),
(21054, 3040, 21889, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:23', '2021-08-18 14:58:23'),
(21055, 10057, 21889, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:51:00', '2021-10-08 11:51:00'),
(21056, 10057, 21889, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:43', '2021-11-19 18:13:43'),
(21057, 10057, 21889, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:26:08', '2021-12-01 13:26:08'),
(21058, 10057, 21889, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 11:03:09', '2021-12-08 11:03:09'),
(21059, 10057, 21889, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:38:47', '2021-12-14 11:38:47'),
(21060, 10057, 21889, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:06:34', '2021-12-21 11:06:34'),
(21061, 10057, 21889, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:50', '2021-12-28 15:06:50'),
(21062, 20067, 21889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:17:00', '2022-01-12 12:17:00'),
(21063, 20067, 21889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:41:03', '2022-01-12 12:41:03'),
(21064, 20067, 21889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:43:12', '2022-01-12 12:43:12'),
(21065, 20067, 21889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Brittany Brown has been loaded in the system effective 9/15/20.  The welcome letter was sent previously.   Please see the attached welcome letter.  Please advise if another request was submitted for the provider.      Thank You', NULL, NULL, '2022-01-12 13:18:58', '2022-01-12 13:18:58'),
(21066, 20067, 21889, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update. Can you please resend me the welcome letter for Brittany Brown  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 13:21:20', '2022-01-12 13:21:20'),
(21067, 20067, 21889, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Hope this email finds you in good spirits. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 Jeny John	1073019493 Brittany Brown	1275163537  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:58:02', '2022-01-20 10:58:02'),
(21068, 20067, 21889, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the updates below for each provider.     Jeny John -  Please allow a few more weeks for the credentialing application to process.   Once approved the request will be sent for loading in the billing system.     There  is no request on file for the remaining providers under the below TIN.    Please submit a contract request form for both providers if you haven’t already done so.  Please remember to submit an updated W9 with contract request forms and send to MHTContractrequest@Molinahealthcare.com.     Thank You,', NULL, NULL, '2022-01-28 15:26:09', '2022-01-28 15:26:09'),
(21069, 20067, 21889, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Thanks for the update kindly see the attached contract request for both providers.  Thank you, Syed Ahad', NULL, NULL, '2022-02-16 15:19:09', '2022-02-16 15:19:09'),
(21070, 20067, 21889, NULL, '2022-03-10 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Good Morning,     The providers have been loaded in the billing system effective 3/15/2022 under all plans.', NULL, NULL, '2022-03-03 15:15:01', '2022-03-03 15:15:01'),
(21071, 3040, 21890, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:13:14', '2021-03-16 12:13:14'),
(21072, 3040, 21890, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:16', '2021-05-28 14:13:16'),
(21073, 3040, 21890, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:26', '2021-06-17 09:07:26');
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
(21074, 3040, 21890, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:57', '2021-07-06 09:22:57'),
(21075, 3040, 21890, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:21', '2021-07-26 15:03:21'),
(21076, 11056, 21890, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:16:47', '2021-08-11 10:16:47'),
(21077, 3040, 21890, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:05', '2021-08-18 15:07:05'),
(21078, 10057, 21890, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:50:51', '2021-10-08 11:50:51'),
(21079, 10057, 21890, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:57:40', '2021-11-15 10:57:40'),
(21080, 3040, 21891, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:13:37', '2021-03-16 12:13:37'),
(21081, 3040, 21891, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:19', '2021-05-28 14:13:19'),
(21082, 3040, 21891, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:22', '2021-06-17 09:07:22'),
(21083, 3040, 21891, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:56', '2021-07-06 09:22:56'),
(21084, 3040, 21891, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:26', '2021-07-26 15:03:26'),
(21085, 11056, 21891, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:10:01', '2021-08-11 10:10:01'),
(21086, 3040, 21891, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:10', '2021-08-18 15:07:10'),
(21087, 10057, 21891, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:50:38', '2021-10-08 11:50:38'),
(21088, 10057, 21891, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:57:12', '2021-11-15 10:57:12'),
(21089, 3040, 21892, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:13:52', '2021-03-16 12:13:52'),
(21090, 3040, 21892, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:21', '2021-05-28 14:13:21'),
(21091, 3040, 21892, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:20', '2021-06-17 09:07:20'),
(21092, 3040, 21892, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:55', '2021-07-06 09:22:55'),
(21093, 3040, 21892, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:19', '2021-07-26 15:03:19'),
(21094, 11056, 21892, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  James Piccione – The request has been sent to credentialing under Emergency Medicine.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2021-08-11 09:10:11', '2021-08-11 09:10:11'),
(21095, 3040, 21892, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:03', '2021-08-18 15:07:03'),
(21096, 12062, 21892, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received email from Michele.Thomas-Martin@molinahealthcare.com on AUG 19,2021;  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,   Thank you for your inquiry.  Please see the status updates listed below.   Provider 1:   Provider Name: Stephen, Ani – The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1588959118   Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.   Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini Philip – The request complete, the request has been loaded under all plans and locations effective 9/1/2021.  Please see the attached welcome letter. Provider NPI# 1841755956   Provider 4:   Provider Name: Fernandus, Limy - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1972005189   Provider 5:   Provider Name: Kourouma , Odette Tiranke – The request is under credentialing.  Please allow a few more weeks for the credentialing application to process. Provider NPI# 1134525868   Provider 6:   Provider Name: Thomas, Cini - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1134777238   Provider 7:   Provider Name: PAUL, SIGI - The request under final step, the request has been sent for loading in the billing system.  Please allow 2-4 weeks for processing. Provider NPI# 1033623616   Thank You,', NULL, NULL, '2021-09-17 13:07:09', '2021-09-17 13:07:09'),
(21097, 12062, 21892, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RESPONDED TO EMAIL ON SEPTEMBER 15,2021;  TO:Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Dear Michele,  Please find my response in green highlighted below;  Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.  The provider will only see patients in urgent care. ', NULL, NULL, '2021-09-17 13:11:23', '2021-09-17 13:11:23'),
(21098, 12062, 21892, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RESPONDED TO EMAIL ON SEPTEMBER 15,2021;  TO:Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Dear Michele,  Please find my response in green highlighted below;  Provider 2:   Provider Name: Piccione JR, James M – I’m waiting on response to the email submitted 8/4/21 - Thank you for submitting the contract request to add the provider as Emergency Medicine.   Please confirm if the provider will only be seeing patients in Urgent Care outpatient setting.  The provider will only see patients in urgent care. ', NULL, NULL, '2021-09-17 13:12:39', '2021-09-17 13:12:39'),
(21099, 12062, 21892, NULL, '2021-09-24 00:00:00.000', 'In Process', 'RECEIVED EMAIL ON SEPTEMBER 17,2021  FROM:Michele.Thomas-Martin@molinahealthcare.com  Subject: RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Record # 179982  Good Morning,  Thank you for your response.   The contract request has been sent to credentialing for processing.  Please allow 30 days for credentialing to process the request.  Thank You,  Michele Thomas-Martin  Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com  Your Extended Family ', NULL, NULL, '2021-09-17 13:15:05', '2021-09-17 13:15:05'),
(21100, 10057, 21892, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:50:30', '2021-10-08 11:50:30'),
(21101, 10057, 21892, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Michele,  Hope you are doing well. Could you please update me with the current status of James Piccione request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-08 11:46:21', '2021-11-08 11:46:21'),
(21102, 10057, 21892, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  The request for James Piccione has been loaded in the billing system effective 11/1/21.  Please see the attached welcome letter.  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:58:53', '2021-11-15 10:58:53'),
(21103, 3040, 21893, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:14:06', '2021-03-16 12:14:06'),
(21104, 3040, 21893, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:24', '2021-05-28 14:13:24'),
(21105, 3040, 21893, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:18', '2021-06-17 09:07:18'),
(21106, 3040, 21893, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:55', '2021-07-06 09:22:55');
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
(21107, 3040, 21893, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:32', '2021-07-26 15:03:32'),
(21108, 11056, 21893, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:24:11', '2021-08-11 09:24:11'),
(21109, 3040, 21893, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:25', '2021-08-18 14:58:25'),
(21110, 10057, 21893, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:50:23', '2021-10-08 11:50:23'),
(21111, 10057, 21893, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:38', '2021-11-19 18:13:38'),
(21112, 10057, 21893, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.  Please see the status for each provider below.  Jaya Jacob – There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Jeena Abraham - There is no request on file.  Please submit a contract request with valid W9 to MHTContractRequest@Molinahealthcare.com.  Vibitha Joseph -  The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.  Julie Rose - The provider was added under the group effective 11/1/2020 under additional locations and under the group effective 9/1/20.    Please see a copy of the welcome letter.  Brittany Brown – The provider was added under the group effective 9/15/2020 .  Please see a copy of the welcome letter.  Glory Abraham - The provider was added under the group effective 7/15/2020.    Please see a copy of the welcome letter.', NULL, NULL, '2021-11-24 14:36:25', '2021-11-24 14:36:25'),
(21113, 3040, 21894, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:14:18', '2021-03-16 12:14:18'),
(21114, 3040, 21894, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:26', '2021-05-28 14:13:26'),
(21115, 3040, 21894, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:15', '2021-06-17 09:07:15'),
(21116, 3040, 21894, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:54', '2021-07-06 09:22:54'),
(21117, 3040, 21894, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:35', '2021-07-26 15:03:35'),
(21118, 11056, 21894, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good morning!  Record # 179917  Hope you are doing well. I am facing an issue regarding the providers mentioned below. I can\'t find the providers on the directory for the additional locations of Longpoint Medical Center & Imperial Valley Urgent Care Center. All of them are showing only for the location of the Normandy Urgent Care centre. Please assist us soon related to the additional locations.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 9: Provider Name: Rauf, Abdur Provider NPI # 14977726202  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 09:51:34', '2021-08-11 09:51:34'),
(21119, 3040, 21894, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject; Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,   Hope you are doing well. Please note I checked the above mentioned providers on the Molina Healthcare provider directory but I couldn\'t find the providers overthere. Would it be possible that you can send me the any confirmation stated that the providers participating under the below locations.   Waiting for your reply.   Thank you ', NULL, NULL, '2021-08-18 14:58:27', '2021-08-18 14:58:27'),
(21120, 10057, 21894, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:50:05', '2021-10-08 11:50:05'),
(21121, 10057, 21894, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:32', '2021-11-19 18:13:32'),
(21122, 10057, 21894, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:25:58', '2021-12-01 13:25:58'),
(21123, 10057, 21894, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 11:03:03', '2021-12-08 11:03:03'),
(21124, 10057, 21894, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:38:41', '2021-12-14 11:38:41'),
(21125, 10057, 21894, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:06:28', '2021-12-21 11:06:28'),
(21126, 10057, 21894, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Molina Provider Contract Update # 185460 - 185463  Good Afternoon,  The provider Jeena Abraham was loaded eff 12/1/17 under all plans ( Medicaid, Dual MMP, Marketplace and Medicare).  Please see a copy of the welcome letter sent in 2017.  The provider listed under all 3 locations.  - Molina ID #’s  Medicaid & Marketplace plans ID # - QMP000005310637  Medicare plan ID #  - QMP000005462770  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-21 14:25:44', '2021-12-21 14:25:44'),
(21127, 3040, 21895, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:14:31', '2021-03-16 12:14:31'),
(21128, 1005, 21895, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:59:10', '2021-06-01 12:59:10'),
(21129, 3040, 21896, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:14:45', '2021-03-16 12:14:45'),
(21130, 3040, 21896, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:28', '2021-05-28 14:13:28'),
(21131, 3040, 21896, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:12', '2021-06-17 09:07:12'),
(21132, 3040, 21896, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-07-06 09:22:53', '2021-07-06 09:22:53'),
(21133, 3040, 21896, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 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: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:18', '2021-07-26 15:03:18'),
(21134, 11056, 21896, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:08:57', '2021-08-11 10:08:57'),
(21135, 3040, 21896, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-08-18 15:07:01', '2021-08-18 15:07:01'),
(21136, 10057, 21896, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:49:41', '2021-10-08 11:49:41'),
(21137, 10057, 21896, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:56:45', '2021-11-15 10:56:45'),
(21138, 3040, 21897, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:14:57', '2021-03-16 12:14:57'),
(21139, 3040, 21897, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:31', '2021-05-28 14:13:31'),
(21140, 3040, 21897, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare 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, '2021-05-28 14:13:33', '2021-05-28 14:13:33'),
(21141, 3040, 21897, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:56', '2021-06-17 09:06:56'),
(21142, 3040, 21897, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:10', '2021-06-17 09:07:10');
