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
(43755, 10057, 30865, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:08:52', '2021-12-16 11:08:52'),
(43756, 10057, 30865, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:17:55', '2021-12-22 10:17:55'),
(43757, 10057, 30865, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:08', '2021-12-29 11:25:08'),
(43758, 19067, 30865, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:25:03', '2022-01-05 11:25:03'),
(43759, 19067, 30865, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:31:51', '2022-01-06 16:31:51'),
(43760, 20067, 30865, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:06:17', '2022-01-14 14:06:17'),
(43761, 20067, 30865, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:37:24', '2022-01-14 14:37:24'),
(43762, 1006, 30866, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:48', '2021-05-14 15:04:48'),
(43763, 3040, 30866, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:59:31', '2021-05-31 14:59:31'),
(43764, 3040, 30866, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:13:50', '2021-06-18 10:13:50'),
(43765, 3040, 30866, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:00', '2021-07-20 11:05:00'),
(43766, 3040, 30866, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:35', '2021-07-22 14:31:35'),
(43767, 1006, 30867, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:48', '2021-05-14 15:04:48'),
(43768, 3040, 30867, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:36', '2021-05-20 16:33:36'),
(43769, 1006, 30879, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:50', '2021-05-14 15:04:50'),
(43770, 3040, 30879, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:00:14', '2021-05-31 14:00:14'),
(43771, 3040, 30879, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:40:08', '2021-06-17 14:40:08'),
(43772, 3040, 30879, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:25', '2021-07-05 16:48:25'),
(43773, 3040, 30879, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:34', '2021-07-26 12:43:34'),
(43774, 11056, 30879, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:27:07', '2021-08-11 16:27:07'),
(43775, 3040, 30879, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:45', '2021-08-18 13:11:45'),
(43776, 1006, 30880, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:50', '2021-05-14 15:04:50'),
(43777, 3040, 30880, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:52', '2021-05-28 14:28:52'),
(43778, 10057, 30880, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:38:05', '2021-12-30 15:38:05'),
(43779, 19067, 30880, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:29:10', '2022-01-05 17:29:10'),
(43780, 20067, 30880, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: rehman@claimsmedinc.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace    Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-06 13:17:53', '2022-01-06 13:17:53'),
(43781, 20067, 30880, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com  Subject: Enrollment || NUCC - IVUC - LPMC || Molina Marketplace   Good afternoon,  Hope you are doing well. I would like to enroll the below-mentioned providers under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI John, Jeny	1073019493 Jacob, Jaya	1194336149   I look forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 13:20:45', '2022-01-06 13:20:45'),
(43782, 20067, 30880, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:16:40', '2022-01-18 09:16:40'),
(43783, 20067, 30880, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:19', '2022-01-28 09:16:19'),
(43784, 20067, 30880, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:32', '2022-02-09 15:29:32'),
(43785, 20067, 30880, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:26', '2022-02-21 09:29:26'),
(43786, 20067, 30880, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:31', '2022-03-01 14:08:31'),
(43787, 20067, 30880, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:11:02', '2022-03-01 14:11:02'),
(43788, 20067, 30880, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:43', '2022-03-18 10:47:43'),
(43789, 19067, 30880, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 03/15/2022. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 15:03:29', '2022-03-30 15:03:29'),
(43790, 1006, 30881, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:50', '2021-05-14 15:04:50'),
(43791, 1019, 30881, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:53:21', '2021-05-31 14:53:21'),
(43792, 3040, 30881, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:35', '2021-06-18 13:20:35'),
(43793, 3040, 30881, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:23:58', '2021-06-18 13:23:58'),
(43794, 3040, 30881, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:14', '2021-07-07 16:52:14'),
(43795, 3040, 30881, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:11', '2021-07-22 11:56:11'),
(43796, 11056, 30881, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:15:22', '2021-08-12 10:15:22'),
(43797, 3040, 30881, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:54', '2021-09-14 17:07:54'),
(43798, 12062, 30881, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537   Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616   Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:34:41', '2021-09-17 12:34:41'),
(43799, 10057, 30881, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:23:00', '2021-10-28 15:23:00'),
(43800, 10057, 30881, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:39:50', '2021-11-22 10:39:50'),
(43801, 10057, 30881, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:02:52', '2021-12-02 14:02:52'),
(43802, 10057, 30881, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:50:14', '2021-12-15 10:50:14'),
(43803, 10057, 30881, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:15', '2021-12-22 12:08:15'),
(43804, 10057, 30881, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:07:27', '2021-12-29 15:07:27'),
(43805, 1006, 30882, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:04:50', '2021-05-14 15:04:50');
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
(43806, 3040, 30882, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 12:42:51', '2021-05-25 12:42:51'),
(43807, 3040, 30882, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:47:34', '2021-06-11 14:47:34'),
(43808, 11056, 30882, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 12:50:42', '2021-06-29 12:50:42'),
(43809, 11056, 30882, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 12:54:10', '2021-06-29 12:54:10'),
(43810, 3040, 30882, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:40', '2021-07-19 09:23:40'),
(43811, 3040, 30882, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:15', '2021-07-28 11:39:15'),
(43812, 11056, 30882, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:07:09', '2021-08-11 17:07:09'),
(43813, 3040, 30882, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:49', '2021-08-17 15:02:49'),
(43814, 3040, 30882, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:46', '2021-09-14 16:14:46'),
(43815, 12062, 30882, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:09:17', '2021-09-22 13:09:17'),
(43816, 10057, 30882, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:37:44', '2021-10-18 16:37:44'),
(43817, 10057, 30882, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:51:04', '2021-11-18 13:51:04'),
(43818, 10057, 30882, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:59:32', '2021-12-01 10:59:32'),
(43819, 10057, 30882, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:52:46', '2021-12-14 09:52:46'),
(43820, 10057, 30882, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:52:46', '2021-12-14 09:52:46'),
(43821, 10057, 30882, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:41:14', '2021-12-20 13:41:14'),
(43822, 10057, 30882, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:57:17', '2021-12-28 11:57:17'),
(43823, 19067, 30882, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:24:05', '2022-01-04 17:24:05'),
(43824, 19067, 30882, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:15', '2022-01-05 11:33:15'),
(43825, 20067, 30882, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:25:30', '2022-01-14 13:25:30'),
(43826, 20067, 30882, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:40', '2022-01-21 16:45:40'),
(43827, 20067, 30882, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:08:41', '2022-01-25 17:08:41'),
(43828, 1006, 30883, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43829, 1006, 30883, NULL, '2021-05-26 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval confirmation and location confirmation are attached for reference. ', NULL, NULL, '2021-05-19 11:18:29', '2021-05-19 11:18:29'),
(43830, 1006, 30884, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43831, 3040, 30884, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: info@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Greetings,   Hope you are doing well. Can you please send me the copy of the executed contract for our group Normandy Urgent Care Center 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  Thank you ', NULL, NULL, '2021-05-28 12:25:04', '2021-05-28 12:25:04'),
(43832, 11056, 30884, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Email rcvd from: MyartL@usamco.com  Subject: Copy of Executed Contract || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || MCO ||  Hello Adil,  Attached is a copy of the executed contract agreement for Normandy Urgent Care Center.  If you have any questions please feel free to give me a call.  Thank you  Group has an ancillary contract. Contract attached. Please see attachment. ', NULL, NULL, '2021-06-16 12:16:10', '2021-06-16 12:16:10'),
(43833, 1006, 30885, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43834, 3040, 30885, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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 13:25:57', '2021-05-28 13:25:57'),
(43835, 3040, 30885, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. Please find the attached ancillary contract request for the below mentioned 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  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-16 16:36:12', '2021-06-16 16:36:12'),
(43836, 3040, 30885, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-05 16:23:11', '2021-07-05 16:23:11'),
(43837, 3040, 30885, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email rcvd from: MHHPContracting@memorialhermann.org  Subject: RE: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning Adil. Both of these Urgent Cares are already contracted and have recently been switched to a new, updated agreement. Once credentialing is verified, I will send a copy of the fully executed agreement to you. If I find that they are not credentialed, our credentialing team will reach out to you. Please let me know if you have any questions.  Thank you.  Camilla Paige', NULL, NULL, '2021-07-23 14:45:54', '2021-07-23 14:45:54'),
(43838, 11056, 30885, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 15:32:25', '2021-08-12 15:32:25'),
(43839, 3040, 30885, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Email rcvd from: ProviderServices@memorialhermann.org  Subject: RE: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good day,  I hope all is well. Provider group is active within our system with the below lines of business and effective dates.  Choice 10/12/2012 Select 10/12/2012 Commerical HMO 1/1/2015 Hybrid HMO 1/1/2019 Hybrid PPO 1/1/2019', NULL, NULL, '2021-08-27 09:59:25', '2021-08-27 09:59:25'),
(43840, 3040, 30885, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:23', '2021-08-27 10:00:23'),
(43841, 1006, 30886, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43842, 1006, 30886, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:20:47', '2021-05-31 16:20:47'),
(43843, 3040, 30886, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:50:06', '2021-06-18 11:50:06'),
(43844, 3040, 30886, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:45:07', '2021-07-06 14:45:07'),
(43845, 3040, 30886, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:31', '2021-07-27 16:53:31'),
(43846, 3040, 30886, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Email rcvd from: vicki.guerra@christushealth.org  Subject: Christus Spohn Health Network - Counties  Hi Adil,  Happy Thursday!  Thank you for speaking with me. The email address CSHNproviderrelations@christushealth.org is not a working email. I apologize for the delay and we are updating our website.  Please click on the website below. It will give you the map of our services areas based on county.  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area  Vicki Ann Guerra  Provider Relations Representative  CHRISTUS Spohn Health Network  613 Elizabeth St Ste 604  Corpus Christi, TX 78404  O: 361-881-3167  F: 361-881-3745', NULL, NULL, '2021-07-28 11:11:47', '2021-07-28 11:11:47'),
(43847, 1006, 30887, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43848, 3040, 30887, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Greetings,   Hope you are doing well. Please find the attached Facility/Ancillary network interest form to enroll in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 10:36:58', '2021-06-02 10:36:58'),
(43849, 3040, 30887, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:16:00', '2021-06-22 11:16:00'),
(43850, 3040, 30887, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-12 14:20:27', '2021-07-12 14:20:27'),
(43851, 11056, 30887, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:52:40', '2021-08-09 08:52:40'),
(43852, 3040, 30887, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:46', '2021-08-17 09:55:46'),
(43853, 10057, 30887, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,  Greetings for the day!  Please be informed that Adil Abbas has quite a job from the facility. After him I\'m the one who is handling all pending tasks & responsibilities, so if you can share further details it will be very helpful for me.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:18:32', '2021-10-11 09:18:32'),
(43854, 10057, 30887, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:22:03', '2021-10-14 11:22:03'),
(43855, 10057, 30887, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 16:16:30', '2021-11-18 16:16:30'),
(43856, 10057, 30887, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:54:23', '2021-12-01 11:54:23'),
(43857, 10057, 30887, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:33:41', '2021-12-08 10:33:41'),
(43858, 10057, 30887, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:08:45', '2021-12-16 11:08:45'),
(43859, 10057, 30887, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:17:50', '2021-12-22 10:17:50'),
(43860, 10057, 30887, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:25:02', '2021-12-29 11:25:02');
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
(43861, 19067, 30887, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:25:27', '2022-01-05 11:25:27'),
(43862, 19067, 30887, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:31:46', '2022-01-06 16:31:46'),
(43863, 20067, 30887, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:06:07', '2022-01-14 14:06:07'),
(43864, 20067, 30887, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:37:07', '2022-01-14 14:37:07'),
(43865, 1006, 30888, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43866, 3040, 30888, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:59:35', '2021-05-31 14:59:35'),
(43867, 11056, 30888, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Request Id: 151161; Request was successfully saved. Group enrollment request sent through Online. Please  see Attachments.', NULL, NULL, '2021-06-18 09:41:22', '2021-06-18 09:41:22'),
(43868, 3040, 30888, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I had a word with (Noiali) Triwest representative and she said the credentialing still in process.   Ref: PH-1315236-N6N2N8 ', NULL, NULL, '2021-06-18 10:08:56', '2021-06-18 10:08:56'),
(43869, 3040, 30888, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-08 11:54:38', '2021-07-08 11:54:38'),
(43870, 3040, 30888, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Email rcvd from: jmonson@triwest.com  Subject:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  HI Adil,     I’ve attached the executed agreement. Please let me know if need anything further.     Thank you,  Jess   ', NULL, NULL, '2021-07-22 14:23:21', '2021-07-22 14:23:21'),
(43871, 1006, 30889, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:01', '2021-05-14 15:05:01'),
(43872, 3040, 30889, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:33:40', '2021-05-20 16:33:40'),
(43873, 1006, 30894, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:02', '2021-05-14 15:05:02'),
(43874, 3040, 30894, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:55', '2021-05-28 14:28:55'),
(43875, 10057, 30894, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:38:01', '2021-12-30 15:38:01'),
(43876, 20067, 30894, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com   Sub: RE: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace    Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,', NULL, NULL, '2022-01-13 13:36:15', '2022-01-13 13:36:15'),
(43877, 20067, 30894, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:16:30', '2022-01-18 09:16:30'),
(43878, 20067, 30894, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:13', '2022-01-28 09:16:13'),
(43879, 20067, 30894, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:39', '2022-02-09 15:29:39'),
(43880, 20067, 30894, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:19', '2022-02-21 09:29:19'),
(43881, 20067, 30894, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:26', '2022-03-01 14:08:26'),
(43882, 20067, 30894, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:10:57', '2022-03-01 14:10:57'),
(43883, 20067, 30894, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:37', '2022-03-18 10:47:37'),
(43884, 22077, 30894, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Subject: Re: Addition of Provider || NUCC || Ancy Kurian || Molina marketplace  Hi,  I would like to know the enrollment process for the following provider  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary & Billing Address	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Ancy Kurian	1316558935  I am looking forward to your kind response!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 14:30:03', '2022-04-15 14:30:03'),
(43885, 1006, 30895, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:02', '2021-05-14 15:05:02'),
(43886, 1019, 30895, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:58:36', '2021-05-31 14:58:36'),
(43887, 3040, 30895, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:20:32', '2021-06-18 13:20:32'),
(43888, 3040, 30895, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:23:57', '2021-06-18 13:23:57'),
(43889, 3040, 30895, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:13', '2021-07-07 16:52:13'),
(43890, 3040, 30895, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:11', '2021-07-22 11:56:11'),
(43891, 11056, 30895, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:15:08', '2021-08-12 10:15:08'),
(43892, 10057, 30895, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Greetings for the day!  Hope you are doing well. I was trying to reach out to know the updated enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations. Also, as per your request please find the attach credentialing application for two highlighted providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI George, Jeemo	1497219067 Stephen, Ani	1588959118 Jose, Julie	1447883061 Brown, Brittany	1275163537 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1073019493  Please feel free to reach out to me. Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-07 10:58:29', '2021-10-07 10:58:29'),
(43893, 10057, 30895, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:22:36', '2021-10-28 15:22:36'),
(43894, 10057, 30895, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:39:42', '2021-11-22 10:39:42'),
(43895, 10057, 30895, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 14:02:06', '2021-12-02 14:02:06'),
(43896, 10057, 30895, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:49:57', '2021-12-15 10:49:57'),
(43897, 10057, 30895, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:53:58', '2021-12-15 10:53:58'),
(43898, 10057, 30895, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:08:09', '2021-12-22 12:08:09'),
(43899, 10057, 30895, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:19:11', '2021-12-29 15:19:11'),
(43900, 20067, 30895, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |   Good afternoon, Hope all is well with you. i would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Abdur Rauf	1497726202 Brittany Brown	1275163537 Vibitha Joseph	1952931560   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:42:04', '2022-01-12 15:42:04'),
(43901, 20067, 30895, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com,  updates@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Evening! Hope you are doing great. Any updates on the below email?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:53:47', '2022-01-18 17:53:47'),
(43902, 20067, 30895, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning!  Hope this email finds you in good health. I would like to know the enrolment status of the below-mentioned providers and if any of them is enrolled kindly send me the welcome kit along with the effective date.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeny John	1407171077	779 Normandy St Ste 114 Houston, TX 77015-3441 Brittany Brown	1275163537	779 Normandy St Ste 114 Houston, TX 77015-3441 Vibitha Joseph	1952931560	779 Normandy St Ste 114 Houston, TX 77015-3441 Group	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:44:28', '2022-01-28 11:44:28'),
(43903, 20067, 30895, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Providers Julie Josie and Jeny John have been credentialed as of 11-23-2021.  This date is for credentialing purposes only and not the effective date.  The Updates Department will respond regarding the effective date, Tax ID link and locations.  Thank you, Nancy', NULL, NULL, '2022-03-02 10:23:06', '2022-03-02 10:23:06'),
(43904, 20067, 30895, NULL, '2022-03-16 00:00:00.000', 'Approved', 'Email received from: patty.albright@primehealthservices.com  Sub: FW: [Fwd: ##RE-168872## : FW: [Fwd: ##RE-168872## : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |]]  Good Afternoon,  All of The providers indicated in your previous email have been added to both locations.  TIN  27-0796429  Julie Jose and Jeny John  Effective date: 11/19/2020     Thanks,', NULL, NULL, '2022-03-09 09:49:39', '2022-03-09 09:49:39'),
(43905, 1006, 30896, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:05:02', '2021-05-14 15:05:02'),
(43906, 3040, 30896, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 12:42:55', '2021-05-25 12:42:55'),
(43907, 3040, 30896, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  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, '2021-06-11 14:47:31', '2021-06-11 14:47:31'),
(43908, 11056, 30896, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 12:54:18', '2021-06-29 12:54:18'),
(43909, 3040, 30896, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN   We cannot contract with an Urgent Care Center with a group contract, the only way the center can become in network is with an Ancillary contract and only the group NPI will show up as in network and can only bill as the group NPI.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, ', NULL, NULL, '2021-07-19 09:15:15', '2021-07-19 09:15:15'),
(43910, 3040, 30896, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Can you please send the ancillary contract so we can start the process for the below mentioned groups. We have 3 different locations under the same Tax ID and NPI number. For your reference I mentioned all the locations below.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-19 09:17:54', '2021-07-19 09:17:54'),
(43911, 3040, 30896, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:15', '2021-07-28 11:39:15'),
(43912, 11056, 30896, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:07:02', '2021-08-11 17:07:02'),
(43913, 3040, 30896, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:48', '2021-08-17 15:02:48'),
(43914, 3040, 30896, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:46', '2021-09-14 16:14:46'),
(43915, 12062, 30896, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:09:06', '2021-09-22 13:09:06');
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
(43916, 10057, 30896, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:37:37', '2021-10-18 16:37:37'),
(43917, 10057, 30896, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:50:53', '2021-11-18 13:50:53'),
(43918, 10057, 30896, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:59:19', '2021-12-01 10:59:19'),
(43919, 10057, 30896, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:52:40', '2021-12-14 09:52:40'),
(43920, 10057, 30896, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:41:06', '2021-12-20 13:41:06'),
(43921, 10057, 30896, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:57:10', '2021-12-28 11:57:10'),
(43922, 19067, 30896, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:27:02', '2022-01-04 17:27:02'),
(43923, 19067, 30896, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:33:10', '2022-01-05 11:33:10'),
(43924, 20067, 30896, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:24:42', '2022-01-14 13:24:42'),
(43925, 20067, 30896, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:32', '2022-01-21 16:45:32'),
(43926, 20067, 30896, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:08:03', '2022-01-25 17:08:03'),
(43927, 1006, 30897, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:06:10', '2021-05-14 15:06:10'),
(43928, 1006, 30897, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	VIBITHA JOSEPH NP PROVIDER PTAN	P02530797 PROVIDER NPI	1952931560 EFFECTIVE DATE	02/11/2020 END DATE	 ', NULL, NULL, '2021-05-17 14:31:08', '2021-05-17 14:31:08'),
(43929, 1006, 30898, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:06:10', '2021-05-14 15:06:10'),
(43930, 1006, 30898, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001293 ', NULL, NULL, '2021-05-17 15:31:20', '2021-05-17 15:31:20'),
(43931, 3040, 30898, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:08', '2021-06-07 17:43:08'),
(43932, 1006, 30899, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:06:47', '2021-05-14 15:06:47'),
(43933, 3040, 30899, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-02 15:37:33', '2021-06-02 15:37:33'),
(43934, 3040, 30899, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,   Hope you are doing well. I wanted to enroll  the below mentioned group and providers in Ambetter 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: Piccione JR, James Provider NPI# 1356321509  Provider 2:  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6:  Provider Name: Thomas, Cini Provider NPI# 1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 17:03:02', '2021-06-21 17:03:02'),
(43935, 11056, 30899, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email sent to : SHP.NetworkDevelopment@superiorhealthplan.com  Sub : Enrollment Forms Submission || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Greetings,  Hope you are doing well. Here are the enrollment forms filled out which you have provided for the below mentioned groups for Superior Health Plan .  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    Providers:  Provider 1:   Provider Name: Piccione JR, James  Provider NPI# : 1356321509    Provider 2:   Provider Name : PAUL, SIGI  Provider NPI# : 1033623616    If you need further information feel free to reach out to me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-09 14:18:23', '2021-07-09 14:18:23'),
(43936, 3040, 30899, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Greetings,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Thomas, Cini  Provider NPI# 1134777238    Provider 2:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 3:   Provider Name: Chennemkara, Mini  Provider NPI# 1841755956    Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 5:   Provider Name: Rauf., Abdur  Provider NPI# 1497726202   Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-07-28 14:10:13', '2021-07-28 14:10:13'),
(43937, 11056, 30899, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  Sub : Fwd: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Good evening!  Hope you are doing well. I want to inquire about the enrollment status for the following providers and practices in Ambetter. Please provide me with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 2:  Provider Name: Piccione JR, James Provider NPI# 1356321509  Provider 3:  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 4:  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 5:  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider 6: Provider Name: Joseph, Molly Provider NPI# 1396380077  If you have any queries or need any documents please let me know. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 16:29:02', '2021-08-13 16:29:02'),
(43938, 3040, 30899, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter || ref#45298  Hello,  I wanted to know the enrollment status for the below mentioned providers in Ambetter in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:   Provider Name: Piccione JR, James  Provider NPI# 1356321509   Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616    Provider 3: Provider Name: Joseph, Molly Provider NPI# 1396380077     Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-08-27 16:43:24', '2021-08-27 16:43:24'),
(43939, 10057, 30899, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status Query - CUCC - Tricare  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in Ambetter.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Piccione JR, James M	1356321509 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Your earliest response will be highly appreciated. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 15:24:35', '2021-10-11 15:24:35'),
(43940, 10057, 30899, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : ECMExecutionTeam@superiorhealthplan.com  Sub : JAMES PICCIONE JR WELCOME LETTER  JAMES PICCIONE JR NORMANDY URGENT CARE CENTER PA rehman@claimsmedinc.com  Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.  Your effective date is:    10/01/2021  ', NULL, NULL, '2021-11-11 14:04:48', '2021-11-11 14:04:48'),
(43941, 1006, 30900, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(43942, 3040, 30900, NULL, '2021-06-04 00:00:00.000', 'In Process', ' Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 13:04:12', '2021-05-28 13:04:12'),
(43943, 3040, 30900, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:59:25', '2021-06-16 16:59:25'),
(43944, 3040, 30900, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:55:15', '2021-07-20 10:55:15'),
(43945, 3040, 30900, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:14:30', '2021-07-27 16:14:30'),
(43946, 1006, 30902, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(43947, 1006, 30902, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Group enrollment request submitted via Wellcare online form, attached in group task for reference.', NULL, NULL, '2021-05-20 21:32:33', '2021-05-20 21:32:33'),
(43948, 3040, 30902, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:50:25', '2021-06-09 10:50:25'),
(43949, 3040, 30902, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:33:04', '2021-07-20 10:33:04'),
(43950, 11056, 30902, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:54:48', '2021-08-11 13:54:48'),
(43951, 10057, 30902, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Wellcare for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Stephen, Ani	1588959118 Jose, Julie	1447883061 Brown, Brittany	1275163537 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1073019493  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-07 10:23:25', '2021-10-07 10:23:25'),
(43952, 10057, 30902, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:49:13', '2021-10-19 11:49:13'),
(43953, 10057, 30902, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:18:55', '2021-11-23 16:18:55'),
(43954, 10057, 30902, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:20:53', '2021-12-02 15:20:53'),
(43955, 10057, 30902, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:23:52', '2021-12-09 13:23:52'),
(43956, 10057, 30902, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:03:37', '2021-12-17 14:03:37'),
(43957, 10057, 30902, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:26:45', '2021-12-23 11:26:45'),
(43958, 10057, 30902, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:58:10', '2021-12-30 13:58:10'),
(43959, 20067, 30902, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:49:43', '2022-01-06 10:49:43'),
(43960, 20067, 30902, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 10:55:01', '2022-01-06 10:55:01'),
(43961, 20067, 30902, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:57:09', '2022-01-14 16:57:09'),
(43962, 20067, 30902, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:22:19', '2022-01-25 10:22:19'),
(43963, 20067, 30902, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:46:10', '2022-02-03 14:46:10'),
(43964, 20067, 30902, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,   Please see list of par providers for Longpoint Medical Center.   Jeny John is almost complete for loading to this contract. I will let you know once complete.', NULL, NULL, '2022-02-08 10:47:39', '2022-02-08 10:47:39'),
(43965, 1006, 30903, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(43966, 3040, 30903, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 17:04:17', '2021-05-28 17:04:17'),
(43967, 11056, 30903, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:50:51', '2021-06-17 13:50:51'),
(43968, 3040, 30903, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:18', '2021-07-05 15:37:18'),
(43969, 3040, 30903, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:31', '2021-07-20 08:04:31'),
(43970, 1006, 30904, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(43971, 1006, 30904, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - LPMC - Christus Spohn   \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416  Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:25:23', '2021-05-31 16:25:23'),
(43972, 3040, 30904, NULL, '2021-06-25 00:00:00.000', 'In Process', '', NULL, NULL, '2021-06-18 11:46:59', '2021-06-18 11:46:59'),
(43973, 3040, 30904, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary 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: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:54', '2021-07-06 14:57:54'),
(43974, 3040, 30904, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:51', '2021-07-27 16:48:51'),
(43975, 10057, 30904, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings for the day!  I want to get the latest update on my credentialing application of below mentioned providers under the facility tax I.D.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1073019493  If you need any further information please let me know, waiting for your prompt response.  Thanks & Regards,', NULL, NULL, '2021-10-06 12:04:18', '2021-10-06 12:04:18'),
(43976, 10057, 30904, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Received From : vicki.guerra@christushealth.org  Sub : Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Hi Steve,  Happy Wednesday!  I will forward this request to the appropriate contact who is Hunter. He will be the one to contact the provider group.  Have a wonderful day.', NULL, NULL, '2021-10-06 12:05:38', '2021-10-06 12:05:38');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(43977, 10057, 30904, NULL, '2021-11-30 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task. ', NULL, NULL, '2021-11-23 11:52:55', '2021-11-23 11:52:55'),
(43978, 1006, 30905, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(43979, 3040, 30905, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:51:56', '2021-06-02 10:51:56'),
(43980, 3040, 30905, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 10:08:29', '2021-07-22 10:08:29'),
(43981, 11056, 30905, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:59:30', '2021-08-09 09:59:30'),
(43982, 3040, 30905, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:57', '2021-08-17 11:31:57'),
(43983, 10057, 30905, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,  Greetings for the day!  Please be informed that Adil Abbas has quite a job from the facility. After him I\'m the one who is handling all pending tasks & responsibilities, so if you can share further details it will be very helpful for me.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:18:17', '2021-10-11 09:18:17'),
(43984, 10057, 30905, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:10:57', '2021-11-09 16:10:57'),
(43985, 10057, 30905, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:03:00', '2021-11-23 17:03:00'),
(43986, 10057, 30905, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:42:43', '2021-12-03 14:42:43'),
(43987, 10057, 30905, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:30:41', '2021-12-10 11:30:41'),
(43988, 10057, 30905, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:38:39', '2021-12-17 10:38:39'),
(43989, 10057, 30905, NULL, '2021-12-30 00:00:00.000', 'In Process', '', NULL, NULL, '2021-12-23 10:32:17', '2021-12-23 10:32:17'),
(43990, 10057, 30905, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:43:09', '2021-12-29 17:43:09'),
(43991, 20067, 30905, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:51:12', '2022-01-11 14:51:12'),
(43992, 20067, 30905, NULL, '2022-01-18 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-11 15:13:34', '2022-01-11 15:13:34'),
(43993, 20067, 30905, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:36:58', '2022-01-19 15:36:58'),
(43994, 20067, 30905, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:46:40', '2022-01-28 13:46:40'),
(43995, 20067, 30905, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:59:33', '2022-02-08 13:59:33'),
(43996, 20067, 30905, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:43:36', '2022-02-16 15:43:36'),
(43997, 20067, 30905, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:56:59', '2022-03-04 15:56:59'),
(43998, 20067, 30905, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:57:04', '2022-03-17 10:57:04'),
(43999, 1006, 30906, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44000, 3040, 30906, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:04:27', '2021-05-31 15:04:27'),
(44001, 11056, 30906, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:35:33', '2021-06-18 10:35:33'),
(44002, 3040, 30906, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Re: Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Hello Jess,   Hope you are doing well. Can you please advise how to enroll the below mentioned group in Triwest. I already submitted the online application for the group.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-20 11:00:05', '2021-07-20 11:00:05'),
(44003, 3040, 30906, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 13:35:43', '2021-07-22 13:35:43'),
(44004, 1006, 30907, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44005, 3040, 30907, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:36:43', '2021-05-20 16:36:43'),
(44006, 1006, 30919, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44007, 3040, 30919, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 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, '2021-05-31 14:01:12', '2021-05-31 14:01:12'),
(44008, 3040, 30919, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 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 13:51:06', '2021-06-17 13:51:06'),
(44009, 11056, 30919, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to :  TXGQProviderRelations@healthspring.com  Sub:  ENROLLMENT INFORMATION OF PROVIDERS- LPMC - Renaissance Physicians   Greetings,  Hope you are doing well. Here is the information of the providers filled in the form which you asked for and kindly see the attachments under below.  Practice Details:  Practice Name:Longpoint Medical Center  Practice Tax ID# 76-0612416  Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 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 further more information please feel free to call or email me. Waiting to hear from you soon.      Thank you!   Please see Attachments for the Form.', NULL, NULL, '2021-06-22 13:17:02', '2021-06-22 13:17:02'),
(44010, 3040, 30919, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com, Chukwuma.Ezeokoli@careallies.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Ezeokoli!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Renaissance Physicians in our group Longpoint Medical Center under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-05 16:42:52', '2021-07-05 16:42:52'),
(44011, 3040, 30919, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Chukwuma.Ezeokoli@careallies.com  Subject: RE: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hi Adil,  Thank you for your interest in joining the Renaissance Physicians Organization (RPO) network! Attached you will find a Letter of Interest, which is required for all prospective providers. Upon completion of the LOI, the West Houston Board will review and determine whether or not Longpoint Medical Center will be added to the network.  Can you please complete the attached Letter of Interest and return it to me at your earliest convenience? Additionally, can you clarify whether you are looking to contract as PCPs in our network or are you looking to contract as an Urgent Care provider?  Feel free to reach out with any questions!  Best, Chuma  Chuma Ezeokoli Network Operations Senior Analyst  CareAllies 2800 North Loop West, Suite 600 Houston, Texas 77092 Email:          Chukwuma.Ezeokoli@CareAllies.com Cell:             +1.832.206.0656 Fax:             +1.832.553.3418   cid:image001.png@01D2E428.EC444E90', NULL, NULL, '2021-07-26 12:54:24', '2021-07-26 12:54:24'),
(44012, 3040, 30919, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Chuma,   Please note that we already sent the forms at TXGQProviderRelations@healthspring.com on 06/22/2021.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:56:17', '2021-07-26 12:56:17'),
(44013, 11056, 30919, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to  :  Chukwuma.Ezeokoli@careallies.   & TXGQProviderRelations@healthspring.com  Sub : Fwd: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:44:06', '2021-08-11 16:44:06'),
(44014, 3040, 30919, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello, Ezeokoli,   I wanted to know the enrollment status for the below mentioned providers and practice in Renaissance Physician in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-09-07 11:24:55', '2021-09-07 11:24:55'),
(44015, 10057, 30919, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practice. Please get back to me as soon as you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1396380077  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 14:51:52', '2021-10-18 14:51:52'),
(44016, 10057, 30919, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com, providerservices@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope all is well with you. Can I get the latest updates on below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:10:20', '2021-11-23 16:10:20'),
(44017, 10057, 30919, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  Kathy Jones Provider Services Representative Cell: 317-744-1241', NULL, NULL, '2021-11-24 09:29:40', '2021-11-24 09:29:40'),
(44018, 10057, 30919, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : kjones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-03 15:52:30', '2021-12-03 15:52:30'),
(44019, 10057, 30919, NULL, '2021-12-22 00:00:00.000', 'Not Eligible', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  *** After discuss with ALEX did it not eligible *** Steve Albert', NULL, NULL, '2021-12-15 13:13:07', '2021-12-15 13:13:07'),
(44020, 1006, 30920, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44021, 3040, 30920, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:28:58', '2021-05-28 14:28:58'),
(44022, 10057, 30920, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:39:54', '2021-12-30 15:39:54'),
(44023, 19067, 30920, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:28:52', '2022-01-05 17:28:52'),
(44024, 20067, 30920, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status ||  Longpoint Medical center || Molina Marketplace  Good Morning! Hope all is well with you. I would like to know the enrollment status of the below-mentioned providers.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 Brown, Brittany	1275163537 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-18 09:40:12', '2022-01-18 09:40:12'),
(44025, 20067, 30920, 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 || Molina Marketplace  Good Morning,     Thank you for your inquiry.  Please see the status updates below for each provider.     Fernandus, Limy - If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Brown, Brittany - provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Jacob, Jaya – The request on file is to load the provider under TIN # 27-0796429.  The request under credentialing.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Thomas, Cini - provider loaded under the service location 9504 Long point but under different TIN # 270796429. If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  Rauf, Abdur – The provider showing under the below location eff 1/1/22  Joseph, Molly -  provider loaded under the service location 9504 Long point but under different TIN # 270796429.  If you would like to add the provider under the below TIN & facility please submit a new request.  If you’ve already submitted the request, please follow up with the contracting mailbox at MHTContractrequest@molinahealthcare.com  for status.  John, Jeny - 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.     Thank You,', NULL, NULL, '2022-01-28 15:21:47', '2022-01-28 15:21:47'),
(44026, 20067, 30920, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace  Good Afternoon,     Thank you for your inquiry.  The request for the below providers have been sent for loading in the billing system for TIN # 76-0612416.  There is no effective date at this time, please allow a few more weeks for this process to complete.     Brittany Brown  Jaya Jacob  Jeny John     There is no request on file for the below providers under TIN # 76-0612416     Fernandus, Limy, Thomas, Cini, Joseph, Molly ', NULL, NULL, '2022-02-16 14:39:30', '2022-02-16 14:39:30'),
(44027, 20067, 30920, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Status || Longpoint Medical center || Molina Marketplace   Good Afternoon!  Hope you had a great weekend. Can you please help me out with the current Credentialing Status of the listed providers?  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 Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202  Thank you, Syed.', NULL, NULL, '2022-03-14 15:13:20', '2022-03-14 15:13:20'),
(44028, 1006, 30921, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44029, 3040, 30921, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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, '2021-05-25 12:46:09', '2021-05-25 12:46:09'),
(44030, 3040, 30921, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Hello, Michal,   Hope you are doing well. Can you please advise how to enroll the group and providers in Christus Health Plan. We need to do the group contract.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-14 08:36:58', '2021-06-14 08:36:58'),
(44031, 3040, 30921, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,  Hope you are doing well. I wanted to add the additional location in Christus Health Plan for our group under the below locations.   Practice Details:  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice 3:   Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 15:02:32', '2021-06-14 15:02:32'),
(44032, 11056, 30921, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enrollment Status || Longpoint Medical Center || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to inquire about the enrollment status of  the below mentioned group and providers in Christus Health Plan.  Practice  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider  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! Have a great day!', NULL, NULL, '2021-06-29 13:14:10', '2021-06-29 13:14:10'),
(44033, 3040, 30921, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:39', '2021-07-19 09:23:39'),
(44034, 3040, 30921, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:14', '2021-07-28 11:39:14'),
(44035, 11056, 30921, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:02:08', '2021-08-11 17:02:08'),
(44036, 3040, 30921, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:48', '2021-08-17 15:02:48'),
(44037, 3040, 30921, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:46', '2021-09-14 16:14:46');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(44038, 12062, 30921, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:19:12', '2021-09-22 13:19:12'),
(44039, 10057, 30921, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:33:46', '2021-10-18 16:33:46'),
(44040, 10057, 30921, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:54:51', '2021-11-23 15:54:51'),
(44041, 10057, 30921, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:34:06', '2021-12-03 14:34:06'),
(44042, 10057, 30921, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 11:02:29', '2021-12-13 11:02:29'),
(44043, 10057, 30921, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:08:20', '2021-12-20 10:08:20'),
(44044, 10057, 30921, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:03:22', '2021-12-28 12:03:22'),
(44045, 20067, 30921, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  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 Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:22:15', '2022-01-10 13:22:15'),
(44046, 20067, 30921, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:25:41', '2022-01-19 15:25:41'),
(44047, 20067, 30921, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:17:55', '2022-01-28 13:17:55'),
(44048, 20067, 30921, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:45:44', '2022-02-08 13:45:44'),
(44049, 20067, 30921, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:52:24', '2022-02-18 09:52:24'),
(44050, 20067, 30921, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:36:45', '2022-03-04 15:36:45'),
(44051, 20067, 30921, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  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 Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:45:31', '2022-03-17 10:45:31'),
(44052, 1006, 30922, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44053, 3040, 30922, NULL, '2021-06-04 00:00:00.000', 'In Process', ' Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 13:04:16', '2021-05-28 13:04:16'),
(44054, 3040, 30922, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:59:22', '2021-06-16 16:59:22'),
(44055, 3040, 30922, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:55:14', '2021-07-20 10:55:14'),
(44056, 3040, 30922, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:14:29', '2021-07-27 16:14:29'),
(44057, 1006, 30924, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44058, 1006, 30924, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Group enrollment request submitted via Wellcare online form, attached in group task for reference.', NULL, NULL, '2021-05-20 21:32:29', '2021-05-20 21:32:29'),
(44059, 3040, 30924, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:50:29', '2021-06-09 10:50:29'),
(44060, 3040, 30924, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:33:04', '2021-07-20 10:33:04'),
(44061, 11056, 30924, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:54:57', '2021-08-11 13:54:57'),
(44062, 3040, 30924, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:00', '2021-09-07 16:28:00'),
(44063, 10057, 30924, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:49:05', '2021-10-19 11:49:05'),
(44064, 10057, 30924, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:18:47', '2021-11-23 16:18:47'),
(44065, 10057, 30924, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:20:44', '2021-12-02 15:20:44'),
(44066, 10057, 30924, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:23:42', '2021-12-09 13:23:42'),
(44067, 10057, 30924, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:03:31', '2021-12-17 14:03:31'),
(44068, 10057, 30924, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:26:39', '2021-12-23 11:26:39'),
(44069, 10057, 30924, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:58:04', '2021-12-30 13:58:04'),
(44070, 20067, 30924, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:50:02', '2022-01-06 10:50:02'),
(44071, 20067, 30924, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 10:55:11', '2022-01-06 10:55:11'),
(44072, 20067, 30924, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:57:20', '2022-01-14 16:57:20'),
(44073, 20067, 30924, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:22:03', '2022-01-25 10:22:03'),
(44074, 20067, 30924, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:46:04', '2022-02-03 14:46:04'),
(44075, 20067, 30924, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,   Please see list of par providers for Longpoint Medical Center.   Jeny John is almost complete for loading to this contract. I will let you know once complete.', NULL, NULL, '2022-02-08 10:43:43', '2022-02-08 10:43:43'),
(44076, 1006, 30925, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44077, 3040, 30925, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 17:04:21', '2021-05-28 17:04:21'),
(44078, 11056, 30925, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:50:08', '2021-06-17 13:50:08'),
(44079, 3040, 30925, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:17', '2021-07-05 15:37:17'),
(44080, 3040, 30925, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:31', '2021-07-20 08:04:31'),
(44081, 1006, 30926, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:17', '2021-05-14 15:13:17'),
(44082, 1006, 30926, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - LPMC - Christus Spohn   \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416  Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:25:11', '2021-05-31 16:25:11'),
(44083, 3040, 30926, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:46:56', '2021-06-18 11:46:56'),
(44084, 3040, 30926, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary 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: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:54', '2021-07-06 14:57:54'),
(44085, 3040, 30926, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:50', '2021-07-27 16:48:50'),
(44086, 3040, 30926, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:29', '2021-07-28 11:20:29'),
(44087, 1006, 30927, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44088, 3040, 30927, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:52:00', '2021-06-02 10:52:00'),
(44089, 3040, 30927, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 10:08:28', '2021-07-22 10:08:28'),
(44090, 11056, 30927, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:59:23', '2021-08-09 09:59:23'),
(44091, 3040, 30927, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:57', '2021-08-17 11:31:57'),
(44092, 10057, 30927, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,  Greetings for the day!  Please be informed that Adil Abbas has quite a job from the facility. After him I\'m the one who is handling all pending tasks & responsibilities, so if you can share further details it will be very helpful for me.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:18:01', '2021-10-11 09:18:01'),
(44093, 10057, 30927, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:10:50', '2021-11-09 16:10:50'),
(44094, 10057, 30927, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:02:47', '2021-11-23 17:02:47'),
(44095, 10057, 30927, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:42:37', '2021-12-03 14:42:37'),
(44096, 10057, 30927, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:30:35', '2021-12-10 11:30:35'),
(44097, 10057, 30927, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:38:33', '2021-12-17 10:38:33'),
(44098, 10057, 30927, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good morning,  I\'m still waiting to get an update from your side?  Your earliest response would be appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-23 10:32:13', '2021-12-23 10:32:13'),
(44099, 10057, 30927, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:43:04', '2021-12-29 17:43:04'),
(44100, 20067, 30927, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:50:53', '2022-01-11 14:50:53'),
(44101, 20067, 30927, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Kindly see the attachments below  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:13:28', '2022-01-11 15:13:28'),
(44102, 20067, 30927, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:36:49', '2022-01-19 15:36:49');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(44103, 20067, 30927, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:46:34', '2022-01-28 13:46:34'),
(44104, 20067, 30927, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:59:27', '2022-02-08 13:59:27'),
(44105, 20067, 30927, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:43:29', '2022-02-16 15:43:29'),
(44106, 20067, 30927, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:56:54', '2022-03-04 15:56:54'),
(44107, 20067, 30927, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:56:58', '2022-03-17 10:56:58'),
(44108, 1006, 30928, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44109, 3040, 30928, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:04:32', '2021-05-31 15:04:32'),
(44110, 11056, 30928, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:35:48', '2021-06-18 10:35:48'),
(44111, 3040, 30928, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Re: Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Hello Jess,   Hope you are doing well. Can you please advise how to enroll the below mentioned group in Triwest. I already submitted the online application for the group.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-20 11:00:05', '2021-07-20 11:00:05'),
(44112, 3040, 30928, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 13:35:43', '2021-07-22 13:35:43'),
(44113, 1006, 30929, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44114, 3040, 30929, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:36:48', '2021-05-20 16:36:48'),
(44115, 1006, 30941, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44116, 3040, 30941, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 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, '2021-05-31 14:01:15', '2021-05-31 14:01:15'),
(44117, 3040, 30941, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 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 13:51:04', '2021-06-17 13:51:04'),
(44118, 11056, 30941, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to :  TXGQProviderRelations@healthspring.com  Sub:  ENROLLMENT INFORMATION OF PROVIDERS- LPMC - Renaissance Physicians   Greetings,  Hope you are doing well. Here is the information of the providers filled in the form which you asked for and kindly see the attachments under below.  Practice Details:  Practice Name:Longpoint Medical Center  Practice Tax ID# 76-0612416  Practice NPI# 1770763815  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 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 further more information please feel free to call or email me. Waiting to hear from you soon.      Thank you!   Please see Attachments for the Form.', NULL, NULL, '2021-06-22 13:19:02', '2021-06-22 13:19:02'),
(44119, 3040, 30941, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com, Chukwuma.Ezeokoli@careallies.com  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Ezeokoli!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Renaissance Physicians in our group Longpoint Medical Center under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-05 16:42:51', '2021-07-05 16:42:51'),
(44120, 3040, 30941, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: Chukwuma.Ezeokoli@careallies.com  Subject: RE: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hi Adil,  Thank you for your interest in joining the Renaissance Physicians Organization (RPO) network! Attached you will find a Letter of Interest, which is required for all prospective providers. Upon completion of the LOI, the West Houston Board will review and determine whether or not Longpoint Medical Center will be added to the network.  Can you please complete the attached Letter of Interest and return it to me at your earliest convenience? Additionally, can you clarify whether you are looking to contract as PCPs in our network or are you looking to contract as an Urgent Care provider?  Feel free to reach out with any questions!  Best, Chuma  Chuma Ezeokoli Network Operations Senior Analyst  CareAllies 2800 North Loop West, Suite 600 Houston, Texas 77092 Email:          Chukwuma.Ezeokoli@CareAllies.com Cell:             +1.832.206.0656 Fax:             +1.832.553.3418   cid:image001.png@01D2E428.EC444E90', NULL, NULL, '2021-07-26 12:54:23', '2021-07-26 12:54:23'),
(44121, 3040, 30941, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Chuma,   Please note that we already sent the forms at TXGQProviderRelations@healthspring.com on 06/22/2021.   If you need further information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:56:16', '2021-07-26 12:56:16'),
(44122, 11056, 30941, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to  :  Chukwuma.Ezeokoli@careallies.   & TXGQProviderRelations@healthspring.com  Sub : Fwd: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:44:17', '2021-08-11 16:44:17'),
(44123, 3040, 30941, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello, Ezeokoli,   I wanted to know the enrollment status for the below mentioned providers and practice in Renaissance Physician in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center  Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-09-07 11:24:55', '2021-09-07 11:24:55'),
(44124, 10057, 30941, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practice. Please get back to me as soon as you get a chance.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1396380077  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 14:51:45', '2021-10-18 14:51:45'),
(44125, 10057, 30941, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : Chukwuma.Ezeokoli@careallies.com, providerservices@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello,  Hope all is well with you. Can I get the latest updates on below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:10:14', '2021-11-23 16:10:14'),
(44126, 10057, 30941, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  Kathy Jones Provider Services Representative Cell: 317-744-1241', NULL, NULL, '2021-11-24 09:29:34', '2021-11-24 09:29:34'),
(44127, 10057, 30941, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : kjones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Thank you for the update. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-03 15:52:21', '2021-12-03 15:52:21'),
(44128, 10057, 30941, NULL, '2021-12-22 00:00:00.000', 'Not Eligible', 'Email Received From : KJones@renaissancefamily.com  Sub : [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Good afternoon! We received your inquiry below. We do not deal with any kind of medical facility we are a dental insurance carrier only. This was sent to us in error. Thanks  *** After discuss with ALEX did it not eligible *** Steve Albert', NULL, NULL, '2021-12-15 13:13:01', '2021-12-15 13:13:01'),
(44129, 1006, 30942, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44130, 3040, 30942, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:29:00', '2021-05-28 14:29:00'),
(44131, 10057, 30942, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Call Details: (855) 322-4080   Rep: Sharona  Reference # SF 5820908  Effective Date: 09/01/2020', NULL, NULL, '2021-12-29 09:16:24', '2021-12-29 09:16:24'),
(44132, 1006, 30943, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44133, 1019, 30943, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com  Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 15:15:40', '2021-05-31 15:15:40'),
(44134, 3040, 30943, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from: colbee.snyder@primehealthservices.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist Prime Health Services, Inc. | 331 Mallory Station Rd Franklin, TN 37067 office 615-565-8701 | fax 615-329-4751 | colbee.snyder@primehealthservices.com', NULL, NULL, '2021-06-18 11:58:03', '2021-06-18 11:58:03'),
(44135, 3040, 30943, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 10:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 11:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 12:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 13:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 14:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 15:     Provider Name:  Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 12:06:57', '2021-06-18 12:06:57'),
(44136, 3040, 30943, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject:  Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,   Hope you are doing well. Please note that I am sending you the CAQH ID for the providers so you can access them. We already allowed the insurance companies to access the CAQH ID for the providers.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 CAQH# 14466957  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 CAQH# 14636793  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 CAQH# 12327279  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 CAQH# 11469023  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 CAQH# 14612332   Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 CAQH# 14634461  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 CAQH# 14381983  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 CAQH# 14564137  Provider 9:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 CAQH# 13558256  Provider 10:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 CAQH# 14618053  Provider 11:   Provider Name: Thomas, Cini Provider NPI# 1134777238 CAQH# 14573031  Provider 12:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 CAQH# 13909329  Provider 13:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 CAQH# 15097678  Provider 14:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 CAQH# 15096463  Provider 15:     Provider Name:  Joseph, Molly Provider NPI# 1396380077 CAQH# 15162165  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 16:26:16', '2021-07-06 16:26:16'),
(44137, 3040, 30943, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email rcvd from: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hi,  We cannot access CAQH applications.  This is why we are asking for them to be emailed to us.  Thank you, Nancy', NULL, NULL, '2021-07-22 10:59:24', '2021-07-22 10:59:24'),
(44138, 3040, 30943, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Re: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,   Hope you are doing well. Please find attached the CAQH application as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 11:02:10', '2021-07-22 11:02:10'),
(44139, 3040, 30943, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:48', '2021-09-14 17:07:48'),
(44140, 10057, 30943, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the enrollment status with Prime Health for our providers under the below mentioned practice.  Group Name Longpoint Medical Center Tax ID	76-0612416 Group NPI 1770763815 Primary Location 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI George, Jeemol 1497219067 Jose, Julie1447883061 Stephen, Ani 1588959118 Piccione JR, James M 1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip 1841755956 Abraham, Glory 1194206490 Fernandus, Limy	1972005189 Kourouma , Odette Tiranke1134525868 Joseph, Vibitha	1952931560 Thomas, Cini 1134777238 Abraham, Jeena 1467901587 PAUL, SIGI 1033623616 Jacob, Jaya 1194336149 John, Jeny 1073019493 Joseph, Molly1396380077  Please let me know the updated status. Furthermore, if you have any questions, please feel free to contact me.  Thanks & Regards,', NULL, NULL, '2021-10-19 14:28:22', '2021-10-19 14:28:22'),
(44141, 10057, 30943, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, megan.wherry@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello,  Greetings for the day!  Any update on the below mentioned enrollment request?  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:55:42', '2021-11-22 10:55:42'),
(44142, 10057, 30943, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : providerrelations@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Follow-up Sent.', NULL, NULL, '2021-12-02 14:14:41', '2021-12-02 14:14:41'),
(44143, 10057, 30943, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Good Afternoon,  Please see the attached Credentialing status roster.  The dates given are for Credentialing purposes only and not the effective date.  Please refer inquiries regarding the effective dates, Tax ID links and locations to: updates@primehealthservices.com  Thank you, Nancy', NULL, NULL, '2021-12-15 11:21:33', '2021-12-15 11:21:33'),
(44144, 10057, 30943, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Nancy,  Thank you for the update. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:12:15', '2021-12-22 12:12:15'),
(44145, 10057, 30943, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:41:49', '2021-12-29 14:41:49'),
(44146, 1006, 30944, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44147, 3040, 30944, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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, '2021-05-25 12:46:13', '2021-05-25 12:46:13'),
(44148, 3040, 30944, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Re: Need to Enroll || Longpoint Medical Center || Group & Providers || CHRISTUS HEALTH PLAN||  Hello, Michal,   Hope you are doing well. Can you please advise how to enroll the group and providers in Christus Health Plan. We need to do the group contract.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-14 08:36:54', '2021-06-14 08:36:54'),
(44149, 3040, 30944, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,  Hope you are doing well. I wanted to add the additional location in Christus Health Plan for our group under the below locations.   Practice Details:  Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2:   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice 3:   Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Tertiary Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-14 15:02:29', '2021-06-14 15:02:29'),
(44150, 11056, 30944, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enrollment Status || Longpoint Medical Center || CHRISTUS HEALTH PLAN ||  Greetings,  Hope you are doing well. I wanted to inquire about the enrollment status of  the below mentioned group and providers in Christus Health Plan.  Practice  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider  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! Have a great day!', NULL, NULL, '2021-06-29 13:14:28', '2021-06-29 13:14:28'),
(44151, 3040, 30944, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:39', '2021-07-19 09:23:39'),
(44152, 3040, 30944, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:14', '2021-07-28 11:39:14'),
(44153, 11056, 30944, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:02:15', '2021-08-11 17:02:15'),
(44154, 11056, 30944, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:02:16', '2021-08-11 17:02:16'),
(44155, 3040, 30944, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:47', '2021-08-17 15:02:47'),
(44156, 3040, 30944, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:45', '2021-09-14 16:14:45'),
(44157, 12062, 30944, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:18:59', '2021-09-22 13:18:59'),
(44158, 10057, 30944, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:33:39', '2021-10-18 16:33:39'),
(44159, 10057, 30944, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Hello,  Hope this email finds you in good health. Could you please let me know the updated status for the below mentioned updated status.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 15:54:44', '2021-11-23 15:54:44'),
(44160, 10057, 30944, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org vicki.guerra@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:33:56', '2021-12-03 14:33:56');
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
(44161, 10057, 30944, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-13 11:02:23', '2021-12-13 11:02:23'),
(44162, 10057, 30944, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 10:08:12', '2021-12-20 10:08:12'),
(44163, 10057, 30944, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 12:03:16', '2021-12-28 12:03:16'),
(44164, 20067, 30944, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good afternoon, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers, if any of them is enrolled kindly send me their welcome letter.  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 Joseph Molly	1396380077 Mini Channamakara	1841755956 Odette Kourouma	1134525868 Jeena Abraham	1467901587 SIGI PAUL	1033623616 Glory Abraham	1194206490 James Piccione JR	1356321509 Limy Fernandus	1972005189 Vibitha Joseph	1952931560 Brittany Brown	1275163537 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238 Jeemol George	1497219067 Julie Jose	1447883061 Jaya Jacob	1194336149 Jeny John	1073019493  Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well. Your earliest response would be greatly appreciated.  Eagerly waiting to hear from you,  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 13:21:51', '2022-01-10 13:21:51'),
(44165, 20067, 30944, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon! Hope this email finds you in good health. I sent the email 9 days ago but I haven\'t received any response yet. Kindly respond to the previous request.  Eager to hear from you. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-19 15:25:35', '2022-01-19 15:25:35'),
(44166, 20067, 30944, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good afternoon!  Hope this email finds you in good health. Kindly respond to the Urgent request.  Eagerly waiting to hear from you. Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:17:47', '2022-01-28 13:17:47'),
(44167, 20067, 30944, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Afternoon  Facility has been processed contract effective date 01/01/22  Thank you', NULL, NULL, '2022-02-08 13:45:39', '2022-02-08 13:45:39'),
(44168, 20067, 30944, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Morning!  Kindly send me a copy of the facility contract. I emailed you on 02/03/2022 and I haven\'t received any response from you yet.  Kindly respond promptly this is my SECOND reminder.  Thank you, ', NULL, NULL, '2022-02-18 09:52:17', '2022-02-18 09:52:17'),
(44169, 20067, 30944, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org  Sub: Re: ENROLLMENT REQUEST- URGENT - LPMC - CHRISTUS HEALTH PLAN  Good Evening!  Kindly send me the copy of the Facility contract. This is my THIRD REMINDER.  Kindly respond promptly.  Thank you,', NULL, NULL, '2022-03-04 15:35:40', '2022-03-04 15:35:40'),
(44170, 20067, 30944, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: jrbrunin@christushealth.org  Sub:  Facility Contract Request || Longpoint Medical Center || Christus Health Plan   Hello Jackie!  This is Syed. I was trying to reach you but you were unavailable over the call. I want a copy of Facility Contract as it is effective from 01/01/2022. Also please confirm to me that all of the 17 providers have been linked to this group.  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 Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Sigi paul	1033623616 Mini Chennemkara	1841755956 Jeena Abraham	1467901587 Odette Kourouma	1134525868 James Piccione	1356321509 Glory Abraham	1194206490 Limy Fernandus	1972005189 Cini Thomas	1134777238 Ani Stephen	1588959118 Jeemol George	1497219067 Julie Jose	1447883061 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Abdur Rauf	1497726202  Thank you,', NULL, NULL, '2022-03-17 10:45:25', '2022-03-17 10:45:25'),
(44171, 1006, 30945, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44172, 3040, 30945, NULL, '2021-06-04 00:00:00.000', 'In Process', ' Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 13:04:19', '2021-05-28 13:04:19'),
(44173, 3040, 30945, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:59:20', '2021-06-16 16:59:20'),
(44174, 3040, 30945, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:55:14', '2021-07-20 10:55:14'),
(44175, 3040, 30945, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:14:28', '2021-07-27 16:14:28'),
(44176, 1006, 30947, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44177, 1006, 30947, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Group enrollment request submitted via Wellcare online form, attached in group task for reference.', NULL, NULL, '2021-05-20 21:32:23', '2021-05-20 21:32:23'),
(44178, 3040, 30947, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:50:33', '2021-06-09 10:50:33'),
(44179, 3040, 30947, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:33:03', '2021-07-20 10:33:03'),
(44180, 11056, 30947, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:55:06', '2021-08-11 13:55:06'),
(44181, 3040, 30947, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:00', '2021-09-07 16:28:00'),
(44182, 10057, 30947, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:48:58', '2021-10-19 11:48:58'),
(44183, 10057, 30947, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:18:39', '2021-11-23 16:18:39'),
(44184, 10057, 30947, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:20:35', '2021-12-02 15:20:35'),
(44185, 10057, 30947, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:23:34', '2021-12-09 13:23:34'),
(44186, 10057, 30947, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:03:25', '2021-12-17 14:03:25'),
(44187, 10057, 30947, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:26:32', '2021-12-23 11:26:32'),
(44188, 10057, 30947, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:57:58', '2021-12-30 13:57:58'),
(44189, 20067, 30947, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:50:12', '2022-01-06 10:50:12'),
(44190, 20067, 30947, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 10:55:22', '2022-01-06 10:55:22'),
(44191, 20067, 30947, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:57:27', '2022-01-14 16:57:27'),
(44192, 20067, 30947, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:21:53', '2022-01-25 10:21:53'),
(44193, 20067, 30947, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:45:57', '2022-02-03 14:45:57'),
(44194, 20067, 30947, NULL, '2022-02-15 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,   Please see list of par providers for Longpoint Medical Center.   Jeny John is almost complete for loading to this contract. I will let you know once complete.', NULL, NULL, '2022-02-08 10:42:32', '2022-02-08 10:42:32'),
(44195, 1006, 30948, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44196, 3040, 30948, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 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 17:04:24', '2021-05-28 17:04:24'),
(44197, 11056, 30948, NULL, '2021-06-24 00:00:00.000', 'In Process', 'EMAIL sent to : lpmc@claimsmedinc.com  Sub:  Provider Update Information Form- TRPN  Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-17 13:49:27', '2021-06-17 13:49:27'),
(44198, 3040, 30948, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group Longpoint Medical Center under the below location. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI: 1770763815 Practice TIN: 76-0612416 Primary Address: 9504 LONG POINT RD STE EHouston , TX 77055-4226  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 8:  Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 9: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 10:  Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 11:  Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 12:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 13:  Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 14:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-05 15:37:17', '2021-07-05 15:37:17'),
(44199, 3040, 30948, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject:  Provider Update Information Form- TRPN  Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 01/01/2021,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 01/01/2021,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/28/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Julie Jose is Active, effective date 01/01/2021,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com', NULL, NULL, '2021-07-20 08:04:30', '2021-07-20 08:04:30'),
(44200, 1006, 30949, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44201, 1006, 30949, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following enrollment request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - LPMC - Christus Spohn   \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416  Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:25:05', '2021-05-31 16:25:05'),
(44202, 3040, 30949, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:46:54', '2021-06-18 11:46:54'),
(44203, 3040, 30949, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary 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: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:53', '2021-07-06 14:57:53'),
(44204, 3040, 30949, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:49', '2021-07-27 16:48:49'),
(44205, 3040, 30949, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:29', '2021-07-28 11:20:29'),
(44206, 1006, 30950, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18'),
(44207, 3040, 30950, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:52:04', '2021-06-02 10:52:04'),
(44208, 3040, 30950, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 10:08:27', '2021-07-22 10:08:27'),
(44209, 11056, 30950, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:59:12', '2021-08-09 09:59:12'),
(44210, 3040, 30950, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:57', '2021-08-17 11:31:57'),
(44211, 10057, 30950, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,  Greetings for the day!  Please be informed that Adil Abbas has quite a job from the facility. After him I\'m the one who is handling all pending tasks & responsibilities, so if you can share further details it will be very helpful for me.  Thanks & Regards,', NULL, NULL, '2021-10-11 09:17:46', '2021-10-11 09:17:46'),
(44212, 10057, 30950, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:10:43', '2021-11-09 16:10:43'),
(44213, 10057, 30950, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:02:40', '2021-11-23 17:02:40'),
(44214, 10057, 30950, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:42:29', '2021-12-03 14:42:29'),
(44215, 10057, 30950, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:30:29', '2021-12-10 11:30:29'),
(44216, 10057, 30950, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:38:27', '2021-12-17 10:38:27'),
(44217, 10057, 30950, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good morning,  I\'m still waiting to get an update from your side?  Your earliest response would be appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-23 10:32:06', '2021-12-23 10:32:06'),
(44218, 10057, 30950, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:42:59', '2021-12-29 17:42:59'),
(44219, 20067, 30950, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:50:46', '2022-01-11 14:50:46'),
(44220, 20067, 30950, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Kindly see the attachments below  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:13:19', '2022-01-11 15:13:19'),
(44221, 20067, 30950, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:36:39', '2022-01-19 15:36:39'),
(44222, 20067, 30950, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:46:26', '2022-01-28 13:46:26'),
(44223, 20067, 30950, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:59:19', '2022-02-08 13:59:19'),
(44224, 20067, 30950, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:43:23', '2022-02-16 15:43:23'),
(44225, 20067, 30950, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:56:46', '2022-03-04 15:56:46'),
(44226, 20067, 30950, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:56:51', '2022-03-17 10:56:51'),
(44227, 1006, 30951, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 15:13:18', '2021-05-14 15:13:18');
