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
(21704, 3040, 21965, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:36', '2021-04-07 13:51:36'),
(21705, 9057, 21965, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:25', '2021-05-26 14:59:25'),
(21706, 1006, 21965, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:05', '2021-06-15 17:08:05'),
(21707, 1006, 21965, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:17', '2021-07-20 10:30:17'),
(21708, 1006, 21965, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:00:18', '2021-08-17 17:00:18'),
(21709, 1006, 21965, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:30:17', '2021-09-01 15:30:17'),
(21710, 11056, 21965, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:26', '2021-09-22 12:07:26'),
(21711, 11056, 21965, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:18', '2021-09-29 17:10:18'),
(21712, 11056, 21965, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:23:22', '2021-10-12 14:23:22'),
(21713, 11056, 21965, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:09', '2021-10-20 12:51:09'),
(21714, 11056, 21965, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:35', '2021-11-10 17:25:35'),
(21715, 11056, 21965, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:35:19', '2021-11-19 17:35:19'),
(21716, 11056, 21965, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:37', '2021-12-01 12:49:37'),
(21717, 11056, 21965, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:07', '2021-12-16 16:38:07'),
(21718, 11056, 21965, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:53', '2021-12-20 15:01:53'),
(21719, 3046, 21966, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:38', '2021-03-16 12:30:38'),
(21720, 3040, 21966, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:53', '2021-04-07 13:51:53'),
(21721, 9057, 21966, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:32', '2021-05-26 14:59:32'),
(21722, 1006, 21966, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:08', '2021-06-15 17:08:08'),
(21723, 1006, 21966, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:31', '2021-07-20 10:30:31'),
(21724, 1006, 21966, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:00:13', '2021-08-17 17:00:13'),
(21725, 1006, 21966, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:30:13', '2021-09-01 15:30:13'),
(21726, 11056, 21966, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:21', '2021-09-22 12:07:21'),
(21727, 11056, 21966, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:23', '2021-09-29 17:10:23'),
(21728, 11056, 21966, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:23:28', '2021-10-12 14:23:28'),
(21729, 11056, 21966, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:17', '2021-10-20 12:51:17'),
(21730, 11056, 21966, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:41', '2021-11-10 17:25:41'),
(21731, 11056, 21966, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:35:37', '2021-11-19 17:35:37'),
(21732, 11056, 21966, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:43', '2021-12-01 12:49:43'),
(21733, 11056, 21966, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:12', '2021-12-16 16:38:12'),
(21734, 11056, 21966, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:39', '2021-12-20 15:01:39'),
(21735, 3046, 21967, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:42', '2021-03-16 12:30:42'),
(21736, 3040, 21967, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:20', '2021-04-07 13:52:20'),
(21737, 9057, 21967, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:39', '2021-05-26 14:59:39'),
(21738, 1006, 21967, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:11', '2021-06-15 17:08:11'),
(21739, 1006, 21967, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:45', '2021-07-20 10:30:45'),
(21740, 1006, 21967, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:00:02', '2021-08-17 17:00:02'),
(21741, 1006, 21967, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:30:10', '2021-09-01 15:30:10'),
(21742, 11056, 21967, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:15', '2021-09-22 12:07:15'),
(21743, 11056, 21967, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:30', '2021-09-29 17:10:30'),
(21744, 11056, 21967, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:23:33', '2021-10-12 14:23:33'),
(21745, 11056, 21967, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:23', '2021-10-20 12:51:23'),
(21746, 11056, 21967, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:48', '2021-11-10 17:25:48'),
(21747, 11056, 21967, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:35:58', '2021-11-19 17:35:58'),
(21748, 11056, 21967, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:51', '2021-12-01 12:49:51'),
(21749, 11056, 21967, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:18', '2021-12-16 16:38:18'),
(21750, 11056, 21967, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:31', '2021-12-20 15:01:31'),
(21751, 3046, 21968, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:45', '2021-03-16 12:30:45'),
(21752, 3040, 21968, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:40', '2021-04-07 13:52:40'),
(21753, 9057, 21968, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:50', '2021-05-26 14:59:50'),
(21754, 1006, 21968, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:18', '2021-06-15 17:08:18'),
(21755, 1006, 21968, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:58', '2021-07-20 10:30:58'),
(21756, 1006, 21968, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:59:54', '2021-08-17 16:59:54'),
(21757, 1006, 21968, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:30:06', '2021-09-01 15:30:06'),
(21758, 11056, 21968, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:08', '2021-09-22 12:07:08'),
(21759, 11056, 21968, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:11:52', '2021-09-29 17:11:52'),
(21760, 11056, 21968, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:23:42', '2021-10-12 14:23:42'),
(21761, 11056, 21968, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:29', '2021-10-20 12:51:29'),
(21762, 11056, 21968, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:54', '2021-11-10 17:25:54'),
(21763, 11056, 21968, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:11', '2021-11-19 17:36:11'),
(21764, 11056, 21968, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:57', '2021-12-01 12:49:57'),
(21765, 11056, 21968, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:22', '2021-12-16 16:38:22'),
(21766, 11056, 21968, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:23', '2021-12-20 15:01:23'),
(21767, 3046, 21969, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:47', '2021-03-16 12:30:47');
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
(21768, 3040, 21969, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:57', '2021-04-07 13:52:57'),
(21769, 9057, 21969, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:57', '2021-05-26 14:59:57'),
(21770, 1006, 21969, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:22', '2021-06-15 17:08:22'),
(21771, 1006, 21969, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:31:55', '2021-07-20 10:31:55'),
(21772, 1006, 21969, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:59:21', '2021-08-17 16:59:21'),
(21773, 1006, 21969, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:29:59', '2021-09-01 15:29:59'),
(21774, 11056, 21969, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:02', '2021-09-22 12:07:02'),
(21775, 11056, 21969, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:12:00', '2021-09-29 17:12:00'),
(21776, 11056, 21969, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:24:06', '2021-10-12 14:24:06'),
(21777, 11056, 21969, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:36', '2021-10-20 12:51:36'),
(21778, 11056, 21969, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:26:01', '2021-11-10 17:26:01'),
(21779, 11056, 21969, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:16', '2021-11-19 17:36:16'),
(21780, 11056, 21969, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:50:02', '2021-12-01 12:50:02'),
(21781, 11056, 21969, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:29', '2021-12-16 16:38:29'),
(21782, 11056, 21969, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:16', '2021-12-20 15:01:16'),
(21783, 3046, 21970, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:51', '2021-03-16 12:30:51'),
(21784, 3040, 21970, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:14', '2021-04-07 13:53:14'),
(21785, 9057, 21970, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:13', '2021-05-26 15:00:13'),
(21786, 1006, 21970, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:26', '2021-06-15 17:08:26'),
(21787, 1006, 21970, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:09', '2021-07-20 10:32:09'),
(21788, 1006, 21970, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:59:15', '2021-08-17 16:59:15'),
(21789, 1006, 21970, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:29:55', '2021-09-01 15:29:55'),
(21790, 11056, 21970, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:10:21', '2021-09-22 12:10:21'),
(21791, 11056, 21970, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:12:07', '2021-09-29 17:12:07'),
(21792, 11056, 21970, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:24:12', '2021-10-12 14:24:12'),
(21793, 11056, 21970, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:24:54', '2021-10-12 14:24:54'),
(21794, 11056, 21970, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:41', '2021-10-20 12:51:41'),
(21795, 11056, 21970, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:26:07', '2021-11-10 17:26:07'),
(21796, 11056, 21970, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:26', '2021-11-19 17:36:26'),
(21797, 11056, 21970, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:50:08', '2021-12-01 12:50:08'),
(21798, 11056, 21970, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:36', '2021-12-16 16:38:36'),
(21799, 11056, 21970, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:09', '2021-12-20 15:01:09'),
(21800, 3046, 21971, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:53', '2021-03-16 12:30:53'),
(21801, 3040, 21971, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:33', '2021-04-07 13:53:33'),
(21802, 9057, 21971, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:21', '2021-05-26 15:00:21'),
(21803, 1006, 21971, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:29', '2021-06-15 17:08:29'),
(21804, 1006, 21971, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:23', '2021-07-20 10:32:23'),
(21805, 1006, 21971, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:59:06', '2021-08-17 16:59:06'),
(21806, 1006, 21971, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:29:52', '2021-09-01 15:29:52'),
(21807, 11056, 21971, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:06:51', '2021-09-22 12:06:51'),
(21808, 11056, 21971, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:12:13', '2021-09-29 17:12:13'),
(21809, 11056, 21971, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:01', '2021-10-12 14:25:01'),
(21810, 11056, 21971, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:48', '2021-10-20 12:51:48'),
(21811, 11056, 21971, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:26:13', '2021-11-10 17:26:13'),
(21812, 11056, 21971, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:32', '2021-11-19 17:36:32'),
(21813, 11056, 21971, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:50:15', '2021-12-01 12:50:15'),
(21814, 11056, 21971, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:43', '2021-12-16 16:38:43'),
(21815, 11056, 21971, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:01:02', '2021-12-20 15:01:02'),
(21816, 3046, 21972, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:55', '2021-03-16 12:30:55'),
(21817, 3040, 21972, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:50', '2021-04-07 13:53:50'),
(21818, 9057, 21972, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:32', '2021-05-26 15:00:32'),
(21819, 1006, 21972, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:32', '2021-06-15 17:08:32'),
(21820, 1006, 21972, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:37', '2021-07-20 10:32:37'),
(21821, 1006, 21972, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:58:49', '2021-08-17 16:58:49'),
(21822, 1006, 21972, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:29:49', '2021-09-01 15:29:49'),
(21823, 11056, 21972, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:06:44', '2021-09-22 12:06:44'),
(21824, 11056, 21972, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:12:20', '2021-09-29 17:12:20'),
(21825, 11056, 21972, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:07', '2021-10-12 14:25:07'),
(21826, 11056, 21972, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:51:56', '2021-10-20 12:51:56'),
(21827, 11056, 21972, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:26:30', '2021-11-10 17:26:30'),
(21828, 11056, 21972, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:38', '2021-11-19 17:36:38'),
(21829, 11056, 21972, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:50:22', '2021-12-01 12:50:22'),
(21830, 11056, 21972, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:48', '2021-12-16 16:38:48'),
(21831, 11056, 21972, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:00:51', '2021-12-20 15:00:51'),
(21832, 3046, 21973, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:58', '2021-03-16 12:30:58');
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
(21833, 3040, 21973, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:54:08', '2021-04-07 13:54:08'),
(21834, 9057, 21973, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:41', '2021-05-26 15:00:41'),
(21835, 1006, 21973, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:35', '2021-06-15 17:08:35'),
(21836, 1006, 21973, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:52', '2021-07-20 10:32:52'),
(21837, 1006, 21973, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 16:58:20', '2021-08-17 16:58:20'),
(21838, 1006, 21973, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:29:46', '2021-09-01 15:29:46'),
(21839, 11056, 21973, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:06:38', '2021-09-22 12:06:38'),
(21840, 11056, 21973, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:12:25', '2021-09-29 17:12:25'),
(21841, 11056, 21973, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:15', '2021-10-12 14:25:15'),
(21842, 11056, 21973, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:52:02', '2021-10-20 12:52:02'),
(21843, 11056, 21973, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:26:38', '2021-11-10 17:26:38'),
(21844, 11056, 21973, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:44', '2021-11-19 17:36:44'),
(21845, 11056, 21973, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:50:28', '2021-12-01 12:50:28'),
(21846, 11056, 21973, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:54', '2021-12-16 16:38:54'),
(21847, 11056, 21973, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   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: 10/1/2021        Facility & Ancillary agreement providers are directly enrolled under the agreement.  Please see the group task.', NULL, NULL, '2021-12-20 15:00:31', '2021-12-20 15:00:31'),
(21848, 3040, 21974, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:31:22', '2021-03-16 12:31:22'),
(21849, 3040, 21974, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:10:51', '2021-06-02 16:10:51'),
(21850, 3040, 21974, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:12', '2021-06-22 09:44:12'),
(21851, 3040, 21974, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:    Provider Name: Stephen, Ani   Provider NPI# 1588959118    Provider 2:    Provider Name: Brown, Brittany  Provider NPI# 1275163537    Provider 3:     Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 4:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.     Thank you   ', NULL, NULL, '2021-07-12 13:56:52', '2021-07-12 13:56:52'),
(21852, 11056, 21974, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:24:05', '2021-08-11 13:24:05'),
(21853, 10057, 21974, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  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 Primary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-06 13:49:28', '2021-10-06 13:49:28'),
(21854, 10057, 21974, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:24:12', '2021-11-11 17:24:12'),
(21855, 10057, 21974, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:16', '2021-12-02 09:49:16'),
(21856, 10057, 21974, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:31:22', '2021-12-15 13:31:22'),
(21857, 10057, 21974, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:14:42', '2021-12-21 15:14:42'),
(21858, 10057, 21974, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:10:20', '2021-12-29 13:10:20'),
(21859, 20067, 21974, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com   Sub: Enrollment Status Query -  Longpoint Medical Center - Tricare   Good Morning! Hope this email finds you in good health. 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 Mini Chennemkara	1841755956 James Piccione JR	1356321509 Ani Stephen	1588959118 Molly Joseph	1396380077  Thanks & Regards Syed Ahad', NULL, NULL, '2022-01-18 10:13:46', '2022-01-18 10:13:46'),
(21860, 20067, 21974, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: Enrollment Status Query - Longpoint Medical Center - Tricare  Good Morning  Syed,  We show all four Providers has been added.  You can check status on a provider by using our self  service Provider Portal see the link highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military', NULL, NULL, '2022-01-19 09:44:05', '2022-01-19 09:44:05'),
(21861, 20067, 21974, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Kindly see the attached Group Roster', NULL, NULL, '2022-01-21 13:13:04', '2022-01-21 13:13:04'),
(21862, 3040, 21975, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:31:38', '2021-03-16 12:31:38'),
(21863, 3040, 21975, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:10:55', '2021-06-02 16:10:55'),
(21864, 3040, 21975, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:09', '2021-06-22 09:44:09'),
(21865, 3040, 21975, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||   Provider 9:    Provider Name: Rauf, Abdur Network to two locations need to submit a request to add her to the Imperial Valley  Provider NPI# 1497726202', NULL, NULL, '2021-07-12 13:27:53', '2021-07-12 13:27:53'),
(21866, 3040, 21976, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:32:02', '2021-03-16 12:32:02'),
(21867, 3040, 21976, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:10:58', '2021-06-02 16:10:58'),
(21868, 3040, 21976, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:07', '2021-06-22 09:44:07'),
(21869, 3040, 21976, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:01', '2021-07-09 14:48:01'),
(21870, 11056, 21976, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:59', '2021-08-11 13:23:59'),
(21871, 3040, 21976, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare 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: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:43', '2021-08-20 14:35:43'),
(21872, 10057, 21976, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & KMoten4@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare 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	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly 1396380077 PAUL, SIGI 1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany 1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:19:48', '2021-10-15 08:19:48'),
(21873, 10057, 21976, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:24:05', '2021-11-11 17:24:05'),
(21874, 10057, 21976, NULL, '2021-12-07 00:00:00.000', 'Approved', 'Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:52:55', '2021-11-30 17:52:55'),
(21875, 3040, 21977, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:32:22', '2021-03-16 12:32:22'),
(21876, 3040, 21977, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:02', '2021-06-02 16:11:02'),
(21877, 3040, 21977, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:05', '2021-06-22 09:44:05'),
(21878, 3040, 21977, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:03', '2021-07-09 14:48:03'),
(21879, 11056, 21977, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:51', '2021-08-11 13:23:51'),
(21880, 3040, 21977, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Ahmed,  Please submit your request for network Group tax id / Providers to the HGB Roster Team email via spreadsheet first, the HGB Roster team has an automatic processing system, they will send you the status once it is complete. You may reach out to me if there is no resolution from the HGB Roster team. HGB Roster team has up to 60 days to process a request.  Here is the status:  Provider Name: Thomas, Cini, Provider NPI# 1134777238 – we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956, -  we show this Provider has been added , I will submit a request to Provider network to display on the Provider Portal  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-20 14:38:21', '2021-08-20 14:38:21');
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
(21881, 10057, 21977, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & KMoten4@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare 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	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly 1396380077 PAUL, SIGI 1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany 1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:19:39', '2021-10-15 08:19:39'),
(21882, 10057, 21977, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:23:58', '2021-11-11 17:23:58'),
(21883, 10057, 21977, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:24', '2021-12-02 09:49:24'),
(21884, 10057, 21977, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:31:17', '2021-12-15 13:31:17'),
(21885, 10057, 21977, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:14:33', '2021-12-21 15:14:33'),
(21886, 10057, 21977, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:10:15', '2021-12-29 13:10:15'),
(21887, 20067, 21977, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:20:54', '2022-01-12 14:20:54'),
(21888, 20067, 21977, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com   Sub: Enrollment Status Query -  Longpoint Medical Center - Tricare   Good Morning! Hope this email finds you in good health. 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 Mini Chennemkara	1841755956 James Piccione JR	1356321509 Ani Stephen	1588959118 Molly Joseph	1396380077  Thanks & Regards Syed Ahad', NULL, NULL, '2022-01-18 10:13:52', '2022-01-18 10:13:52'),
(21889, 20067, 21977, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: Enrollment Status Query - Longpoint Medical Center - Tricare  Good Morning  Syed,  We show all four Providers has been added.  You can check status on a provider by using our self  service Provider Portal see the link highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military', NULL, NULL, '2022-01-19 09:43:58', '2022-01-19 09:43:58'),
(21890, 20067, 21977, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Called Tricare and spoke to Ashley  Provider is In-Network Provider ID: 471914151-77055-A010 Effective date: 01/15/2022 Ref# 14977155 ', NULL, NULL, '2022-01-21 12:47:33', '2022-01-21 12:47:33'),
(21891, 3040, 21978, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:32:54', '2021-03-16 12:32:54'),
(21892, 3040, 21978, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:06', '2021-06-02 16:11:06'),
(21893, 3040, 21978, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:02', '2021-06-22 09:44:02'),
(21894, 3040, 21978, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Need Effective Date || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers ||  Hello,   Hope you are doing well. As per your email the below mentioned providers are participating with Tricare in our group under the below locations. Can you please send the effective date.   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: Abraham, Glory (Need Effective Date) Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy (Need Effective Date) Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:41:30', '2021-07-09 14:41:30'),
(21895, 3040, 21978, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare || Provider 7:    Provider Name: Abraham, Glory- network all three locations  Provider NPI# 1194206490', NULL, NULL, '2021-07-12 13:29:21', '2021-07-12 13:29:21'),
(21896, 3040, 21979, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:33:08', '2021-03-16 12:33:08'),
(21897, 3040, 21979, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:11', '2021-06-02 16:11:11'),
(21898, 3040, 21979, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:44:00', '2021-06-22 09:44:00'),
(21899, 3040, 21979, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,   Hope you are doing well. I wanted to add the location under the below mentioned providers in Tricare in 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  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: Jose, Julie Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:   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 5:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:   Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-07-09 14:33:16', '2021-07-09 14:33:16'),
(21900, 11056, 21979, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from :    ywyatt@humana.com  Sub : Fwd: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Morning Adil,     To add a provider to a network location you need to complete the attached spreadsheet and email it to the HGB Roster team to process.     Send the completed spreadsheet to the following email address     HGBProviderRosters@Humana.com              Thanks,  Yvonne', NULL, NULL, '2021-08-11 11:28:42', '2021-08-11 11:28:42'),
(21901, 3040, 21979, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com, ywyatt@humana.com  Subject: Re: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Received Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in an additional location in Tricare in our group under the below highlighted locations. We already submitted the roster for an additional location on 07/19/2021.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider 1:     Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 2:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:    Provider Name: Rauf, Abdur   Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:    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 5:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:    Provider Name: Thomas, Cini   Provider NPI# 1134777238  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226   Provider 7:    Provider Name: Abraham, Jeena   Provider NPI# 1467901587  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!! ', NULL, NULL, '2021-08-18 16:51:44', '2021-08-18 16:51:44'),
(21902, 3040, 21979, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Additional Location || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Good Afternoon Adil,  We show the following.  This information is available on the Providers Portal or directory Highlighted is the link to check status. I have attached a copy of the spreadsheet of the Providers we show affiliated to these groups under this tax id.   https://infocenter.humana-military.com/provider/service/Account/Login  HumanaMilitary - Find care (goperspecta.com)  Provider 1:   Provider Name: Jose, Julie- Show has been added Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 – Show added Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226- Show not added yet  Provider 3:  Show Added Provider Name: Rauf, Abdur  Provider NPI# 1497726202 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 4:  Show added to both locations 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 5:  - Show added Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 6:   Provider Name: Thomas, Cini – show added to all three locations Provider NPI# 1134777238 Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 7:  - Show added. Provider Name: Abraham, Jeena  Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-09-01 13:08:18', '2021-09-01 13:08:18'),
(21903, 3040, 21980, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:33:40', '2021-03-16 12:33:40'),
(21904, 3040, 21980, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:15', '2021-06-02 16:11:15'),
(21905, 3040, 21980, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:57', '2021-06-22 09:43:57'),
(21906, 3040, 21980, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:47:59', '2021-07-09 14:47:59'),
(21907, 11056, 21980, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:44', '2021-08-11 13:23:44'),
(21908, 3040, 21980, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare 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: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:42', '2021-08-20 14:35:42'),
(21909, 10057, 21980, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & KMoten4@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare 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	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly 1396380077 PAUL, SIGI 1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany 1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:19:26', '2021-10-15 08:19:26'),
(21910, 10057, 21980, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:23:52', '2021-11-11 17:23:52'),
(21911, 10057, 21980, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning,  Hope this email finds you well. Could you please let me know the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 09:49:31', '2021-12-02 09:49:31'),
(21912, 10057, 21980, NULL, '2021-12-22 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Morning Steve,  The status is listed below. You can check status by using the self-service Provider Portal.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt, TRICARE Community Liaison II Humana Military', NULL, NULL, '2021-12-15 13:31:11', '2021-12-15 13:31:11'),
(21913, 10057, 21980, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Thank you for reaching out. Unfortunately, we do not have access to the provider self service portal. Is there any way that we can get the status for below mentioned providers enrollment status?  Your earliest response will be highly appreciated.  Kind Regards, Steve Albert ', NULL, NULL, '2021-12-21 15:14:26', '2021-12-21 15:14:26'),
(21914, 10057, 21980, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  We are requesting Providers to create a log in on the Provider Portal highlighted below is the link', NULL, NULL, '2021-12-29 13:10:10', '2021-12-29 13:10:10'),
(21915, 20067, 21980, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  ywyatt@humana.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon, Hope this email finds you well. I would like to know the enrollment status of the below-mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:21:23', '2022-01-12 14:21:23'),
(21916, 20067, 21980, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com   Sub: Enrollment Status Query -  Longpoint Medical Center - Tricare   Good Morning! Hope this email finds you in good health. 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 Mini Chennemkara	1841755956 James Piccione JR	1356321509 Ani Stephen	1588959118 Molly Joseph	1396380077  Thanks & Regards Syed Ahad', NULL, NULL, '2022-01-18 10:13:59', '2022-01-18 10:13:59'),
(21917, 20067, 21980, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Sub: Enrollment Status Query - Longpoint Medical Center - Tricare  Good Morning  Syed,  We show all four Providers has been added.  You can check status on a provider by using our self  service Provider Portal see the link highlighted below.  In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.  Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military', NULL, NULL, '2022-01-19 09:43:51', '2022-01-19 09:43:51'),
(21918, 20067, 21980, NULL, '2022-01-28 00:00:00.000', 'Approved', 'Called Tricare and spoke to Ashley  Provider is In-Network Id: 471914151-77055-A011 Effective 01/15/2022 Ref# 14977181 ', NULL, NULL, '2022-01-21 12:52:22', '2022-01-21 12:52:22'),
(21919, 3040, 21981, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:34:00', '2021-03-16 12:34:00'),
(21920, 3040, 21981, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:18', '2021-06-02 16:11:18'),
(21921, 3040, 21981, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-22 11:12:59', '2021-06-22 11:12:59'),
(21922, 3040, 21981, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Hello,   Please advise me the enrollment status for the below mentioned provider in Tricare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-09 14:48:05', '2021-07-09 14:48:05'),
(21923, 11056, 21981, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : KMoten4@humana.com   &     ywyatt@humana.com  Sub :  Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you!  Have a great day!', NULL, NULL, '2021-08-11 13:23:38', '2021-08-11 13:23:38'),
(21924, 3040, 21981, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. Please find attached roster as per Yvonne Wyatt email to enroll the below mentioned providers in Tricare 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: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  If you need any document or information please let me know. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-20 14:35:40', '2021-08-20 14:35:40');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(21925, 10057, 21981, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com & KMoten4@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and provider in Tricare 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	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Joseph, Molly 1396380077 PAUL, SIGI 1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Brown, Brittany 1275163537 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you have time!  Thanks & Regards,', NULL, NULL, '2021-10-15 08:19:16', '2021-10-15 08:19:16'),
(21926, 10057, 21981, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:23:45', '2021-11-11 17:23:45'),
(21927, 10057, 21981, NULL, '2021-12-07 00:00:00.000', 'Approved', '	 Email Received From : ywyatt@humana.com  Sub : Fwd: Need Copy of Welcome Letters & Updated Group Roster - Humana/Tricare - Houston  Good Morning  Alex,  I have attached a copy of the contract, the request to add Imperial Valley Urgent Care Center along with the roster for Normandy Urgent Care Center and Imperial Valley Urgent Care.  The Welcome letter was sent via email we do not keep a copy of the welcome letter.  We do not show we have a contract on file for Long point Medical Center.  Thanks, Yvonne W. Wyatt,', NULL, NULL, '2021-11-30 17:56:31', '2021-11-30 17:56:31'),
(21928, 3040, 21982, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:34:11', '2021-03-16 12:34:11'),
(21929, 3040, 21982, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Tricare ||  Hello Katherine,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-02 16:11:22', '2021-06-02 16:11:22'),
(21930, 3040, 21982, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Tricare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-22 09:43:53', '2021-06-22 09:43:53'),
(21931, 3040, 21982, NULL, '2021-07-19 00:00:00.000', 'Not Eligible', 'provider is no longer working with practice. ', NULL, NULL, '2021-07-12 13:54:51', '2021-07-12 13:54:51'),
(21932, 3046, 21983, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:34:18', '2021-03-16 12:34:18'),
(21933, 3040, 21983, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:57:43', '2021-04-08 14:57:43'),
(21934, 9057, 21983, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:46:16', '2021-05-26 15:46:16'),
(21935, 3040, 21983, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:07', '2021-06-15 17:01:07'),
(21936, 1006, 21983, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Sent f/u and address addition email @ ccampos@trpnppo.com:  Sub: Group enrollment & address addition query   \"Hello Carlos,  I wanted to verify what the effective date of the following group is, also we wanted to add the following location under the group and the following provider as well:   Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Provider Name: Traci Mason NPI# 1497127831  Additional Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please let me know if you have any questions.  Thank you!\"', NULL, NULL, '2021-06-23 10:53:26', '2021-06-23 10:53:26'),
(21937, 1006, 21983, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ ccampos@trpnppo.com & providerrelations@trpnppo.com:   Sub: Group enrollment & address addition query  \"Hello Carlos,   I hope you\'re doing well, I wanted to check in on the status of this request. I would appreciate it if you could please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-08 17:24:53', '2021-07-08 17:24:53'),
(21938, 1006, 21983, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from ccampos@trpnppo.com:  Sub: RE: Group enrollment & address addition query  \"Hello Brad,   This group is Active, effective date 04/26/2016,   Provider Traci Mason is Active, effective date 01/01/2021,   Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com\"  Replied with:   \"Hello Carlos,   I appreciate the update but the address mentioned is still not showing up under the provider or group on the TRPN provider directory, could you let me know when that will be updated?  Thank you!\"', NULL, NULL, '2021-07-13 08:36:54', '2021-07-13 08:36:54'),
(21939, 1006, 21983, NULL, '2021-08-31 00:00:00.000', 'Approved', 'All providers have been added to the group address. Approving task.   Eff: 04/26/2016', NULL, NULL, '2021-08-24 10:59:16', '2021-08-24 10:59:16'),
(21940, 3040, 21984, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:34:41', '2021-03-16 12:34:41'),
(21941, 1006, 21984, 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 15:07:38', '2021-05-19 15:07:38'),
(21942, 3040, 21985, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:34:55', '2021-03-16 12:34:55'),
(21943, 1006, 21985, 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 15:07:39', '2021-05-19 15:07:39'),
(21944, 3046, 21986, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:02', '2021-03-16 12:35:02'),
(21945, 3040, 21986, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:16', '2021-04-08 14:58:16'),
(21946, 3040, 21986, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:19', '2021-04-09 12:36:19'),
(21947, 9057, 21986, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:46:41', '2021-05-26 15:46:41'),
(21948, 3040, 21986, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:05', '2021-06-15 17:01:05'),
(21949, 1006, 21986, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:26:46', '2021-06-23 11:26:46'),
(21950, 3046, 21987, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:04', '2021-03-16 12:35:04'),
(21951, 3040, 21987, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:50', '2021-04-08 14:58:50'),
(21952, 3040, 21987, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:22', '2021-04-09 12:36:22'),
(21953, 9057, 21987, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:46:53', '2021-05-26 15:46:53'),
(21954, 3040, 21987, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:03', '2021-06-15 17:01:03'),
(21955, 1006, 21987, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:26:27', '2021-06-23 11:26:27'),
(21956, 3046, 21988, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:06', '2021-03-16 12:35:06'),
(21957, 3040, 21988, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:59:54', '2021-04-08 14:59:54'),
(21958, 3040, 21988, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:25', '2021-04-09 12:36:25'),
(21959, 9057, 21988, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:02', '2021-05-26 15:47:02'),
(21960, 3040, 21988, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:01:00', '2021-06-15 17:01:00'),
(21961, 1006, 21988, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:26:03', '2021-06-23 11:26:03'),
(21962, 3046, 21989, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:08', '2021-03-16 12:35:08'),
(21963, 3040, 21989, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:34:04', '2021-04-08 15:34:04'),
(21964, 3040, 21989, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:28', '2021-04-09 12:36:28'),
(21965, 9057, 21989, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:09', '2021-05-26 15:47:09'),
(21966, 3040, 21989, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:59', '2021-06-15 17:00:59'),
(21967, 1006, 21989, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:25:37', '2021-06-23 11:25:37'),
(21968, 3046, 21990, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:10', '2021-03-16 12:35:10'),
(21969, 3040, 21990, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:34:49', '2021-04-08 15:34:49'),
(21970, 3040, 21990, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:33', '2021-04-09 12:36:33'),
(21971, 9057, 21990, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:20', '2021-05-26 15:47:20'),
(21972, 3040, 21990, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:58', '2021-06-15 17:00:58'),
(21973, 1006, 21990, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:25:09', '2021-06-23 11:25:09'),
(21974, 3046, 21991, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:16', '2021-03-16 12:35:16'),
(21975, 3040, 21991, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:27', '2021-04-08 15:35:27');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(21976, 3040, 21991, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:06', '2021-04-09 12:50:06'),
(21977, 9057, 21991, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:29', '2021-05-26 15:47:29'),
(21978, 3040, 21991, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:55', '2021-06-15 17:00:55'),
(21979, 1006, 21991, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:24:39', '2021-06-23 11:24:39'),
(21980, 3046, 21992, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:18', '2021-03-16 12:35:18'),
(21981, 3040, 21992, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:57', '2021-04-08 15:35:57'),
(21982, 3040, 21992, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:19', '2021-04-09 12:50:19'),
(21983, 9057, 21992, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:42', '2021-05-26 15:47:42'),
(21984, 3040, 21992, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:54', '2021-06-15 17:00:54'),
(21985, 1006, 21992, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:24:14', '2021-06-23 11:24:14'),
(21986, 3046, 21993, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:20', '2021-03-16 12:35:20'),
(21987, 3040, 21993, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:25', '2021-04-08 15:36:25'),
(21988, 3040, 21993, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:35', '2021-04-09 12:50:35'),
(21989, 9057, 21993, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:47:53', '2021-05-26 15:47:53'),
(21990, 3040, 21993, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:51', '2021-06-15 17:00:51'),
(21991, 1006, 21993, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:23:47', '2021-06-23 11:23:47'),
(21992, 3046, 21994, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:22', '2021-03-16 12:35:22'),
(21993, 3040, 21994, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:57', '2021-04-08 15:36:57'),
(21994, 3040, 21994, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:51', '2021-04-09 12:50:51'),
(21995, 9057, 21994, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:48:32', '2021-05-26 15:48:32'),
(21996, 3040, 21994, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:49', '2021-06-15 17:00:49'),
(21997, 1006, 21994, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:23:24', '2021-06-23 11:23:24'),
(21998, 3046, 21995, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:25', '2021-03-16 12:35:25'),
(21999, 3040, 21995, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:37:25', '2021-04-08 15:37:25'),
(22000, 3040, 21995, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:51:08', '2021-04-09 12:51:08'),
(22001, 9057, 21995, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:48:44', '2021-05-26 15:48:44'),
(22002, 3040, 21995, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:47', '2021-06-15 17:00:47'),
(22003, 1006, 21995, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021', NULL, NULL, '2021-06-23 11:21:52', '2021-06-23 11:21:52'),
(22004, 3040, 21996, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:35:46', '2021-03-16 12:35:46'),
(22005, 1006, 21996, 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 15:07:43', '2021-05-19 15:07:43'),
(22006, 3040, 21997, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:36:15', '2021-03-16 12:36:15'),
(22007, 1006, 21997, 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 15:07:48', '2021-05-19 15:07:48'),
(22008, 3040, 21998, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:36:24', '2021-03-16 12:36:24'),
(22009, 1006, 21998, NULL, '2021-05-26 00:00:00.000', 'Not Eligible', 'The provider is no longer active with the group. ', NULL, NULL, '2021-05-19 14:57:33', '2021-05-19 14:57:33'),
(22010, 3040, 21999, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:36:48', '2021-03-16 12:36:48'),
(22011, 1006, 21999, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Provider enrollment request has been submitted via Optum Link. ', NULL, NULL, '2021-05-20 08:42:44', '2021-05-20 08:42:44'),
(22012, 3040, 21999, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to:  networkhelp@uhc.com  Subject: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:48:10', '2021-06-08 14:48:10'),
(22013, 3040, 21999, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from aldean_mosley@uhc.com  Good morning,  Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed Jacob, Jaya, and  PAUL, SIGI /TAX ID 270796429 regarding enrollment status for provider’s. . Per your provider’s profile, I can confirm that I located a work order request PR-5921427 to add non participating provider’s to group. This work order is not complete, I recommend that you allow more time to complete, you should follow-up in 10 days on PR-5921427.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. If sent to aldean_mosley@uhc.com, it will be considered responded to already and will be deleted.  Have a wonderful day!  Thank You,  Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 12:03:35', '2021-06-25 12:03:35'),
(22014, 3040, 21999, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for 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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 12:04:43', '2021-06-25 12:04:43'),
(22015, 3040, 21999, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in United Healthcare for 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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-15 14:54:42', '2021-07-15 14:54:42'),
(22016, 1006, 21999, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from networkhelp@uhc.com:  Sub: Secure Message from brian_k_autio@uhc.com  \"Good morning,  Thank you for contacting the Network Management Resource Team. Both providers, Jaya Jacob and Sigi Paul, have been linked to the Tax ID 270796429 for Normandy Urgent Care Center, but they are currently not contracted yet. The request, PR-5921427, is still in process to get the group contract loaded. Please allow additional time for the request to get completed.  Please let us know if we can assist further via email. All responses must only be sent to networkhelp@uhc.com, so we don’t receive duplicate emails. Any emails sent to my personal email will be deleted.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Brian K. Autio  Associate Network Contractor United Healthcare Network Management Resource Team (NMRT)  For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.    For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.  Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation\"', NULL, NULL, '2021-08-03 14:34:40', '2021-08-03 14:34:40'),
(22017, 11056, 21999, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :  networkhelp@uhc.com  Sub : Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Good afternoon!  Hope all is well. This is just a follow up email regarding the enrollment status of below mentioned providers and practice in UHC. Are they contracted now?  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 Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 15:29:14', '2021-08-11 15:29:14'),
(22018, 3040, 21999, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david.c.cliff@optum.com   Provider Name: Jacob, Jaya  A request to add this provider to the group and group contract is in process under PR-6026374 Provider NPI# 1194336149  Provider Name: PAUL, SIGI  A request to add this provider to the group and group contract is in process under PR-6026374 Provider NPI# 1033623616  Provider Name: John, Jeny   A request to add this provider to the group and group contract is in process under PR-6042930 Provider NPI# : 1073019493  *** Please allow more time for these requests to complete ***  David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-08-30 11:16:56', '2021-08-30 11:16:56'),
(22019, 3040, 21999, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below locations.   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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3; Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-30 11:20:14', '2021-08-30 11:20:14'),
(22020, 3040, 21999, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject:  Secure Message from david.c.cliff@optum.com  Good Afternoon,  Provider Name: Jacob, Jaya  provider was added to the group contract with an effective date of 7/19/2021  The address provided below is not a service location for this provider under this TIN Provider NPI# 1194336149  Provider Name: PAUL, SIGI  Jaya  provider was added to the group contract with an effective date of 7/19/2021  The address provided below is not a service location for this provider under this TIN Provider NPI# 1033623616  Provider Name: John, Jeny  provider has no active contracts loaded under this TIN  The address provided below is not a service location for this provider under this TIN   Provider NPI# : 1073019493  David Cliff UnitedHealthcare Network Management Resource Team (NMRT) ', NULL, NULL, '2021-09-03 10:21:03', '2021-09-03 10:21:03'),
(22021, 10057, 21999, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Your earliest response will be highly appreciated. Have a great evening.  Thanks & Regards,', NULL, NULL, '2021-10-14 16:26:47', '2021-10-14 16:26:47'),
(22022, 10057, 21999, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Good Afternoon,  Can I get the latest update on our below mentioned providers enrollment request?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 14:23:38', '2021-11-23 14:23:38'),
(22023, 10057, 21999, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Please revert back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-03 16:10:21', '2021-12-03 16:10:21'),
(22024, 10057, 21999, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-10 15:07:19', '2021-12-10 15:07:19'),
(22025, 10057, 21999, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below location.   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 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com Joseph, Molly 1396380077 â€“ Provider is participating effective 08/23/2021 PAUL, SIGI 1033623616 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com Jacob, Jaya 1194336149 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com  Thank you.', NULL, NULL, '2021-12-17 13:40:05', '2021-12-17 13:40:05'),
(22026, 10057, 21999, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Please find the attached form.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-23 10:59:32', '2021-12-23 10:59:32'),
(22027, 10057, 21999, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : hpdemo@uhc.com  Sub : Jaya Jacob || Longpoint Medical Center || UHC  Please find the attached form.  Thanks & Regards, Steve Albert', NULL, NULL, '2021-12-23 11:00:30', '2021-12-23 11:00:30'),
(22028, 10057, 21999, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-30 13:20:33', '2021-12-30 13:20:33'),
(22029, 20067, 21999, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || UHC ||  Good afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider under Longpoint Medical Center.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226 Jaya Jacob	1194336149	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-06 14:28:33', '2022-01-06 14:28:33'),
(22030, 20067, 21999, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Morning!  Hope this email finds you in good health. Any update on the previous request?  Your early response will be greatly appreciated. Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 09:56:04', '2022-01-18 09:56:04'),
(22031, 20067, 21999, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from:  networkhelpresponse@uhc.com  Sub: Re Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Thank you for contacting the Network Management Resource Team. I have verified credentialing for [Ancy Kurian-] is showing as [ -processing -]. Credentialing approval does not imply or guarantee participation with the health plans. Approved and signed physician contracts are required for participation.( affiliated with group tax id as of 12/22/2021)    If you’re joining a medical group that already has a participation agreement with UnitedHealthcare, you won’t receive a contract directly. Instead, you’ll be added to the group agreement once your credentialing application has been approved. (This can take up to three weeks once credentialing is approved.)    If you are joining a medical group or practice that is wanting to join the network, once the agreement has been approved if you’ve given us an email address, we’ll send you the contract through the secure DocuSign application. If not, we’ll send it to you by U.S. mail.     For more information and resources, please visit https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-contracted.html.     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team              Re- Enrollment Status || LPMC || Provider || UHC || Good Morning! Hope this email finds you in good health. Any update on the previous request? Your early response will be greatly appreciated. Thanks and Regards,   This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-28 15:08:47', '2022-01-28 15:08:47'),
(22032, 20067, 21999, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Re: Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Good afternoon!  Hope this email finds you well. I would like to know the enrollment status of these providers under the below-mentioned TIN#.  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 Ancy Kurian	1316558935 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jeny John	1073019493  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-21 17:57:11', '2022-02-21 17:57:11'),
(22033, 19067, 21999, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure email received from: nelly_tully@uhc.com  Subject: Jaya Jacob || Longpoint Medical Center || UHC   Good morning,     Please provide the Medicare ID for JAYA JACOB in order for the product to be loaded.     Thank you        Nelly Tully     Sr. Provider Data Analyst  Contract Analytics Team – Central Region TX & KY  UnitedHealth Group   ', NULL, NULL, '2022-03-08 11:53:47', '2022-03-08 11:53:47'),
(22034, 19067, 21999, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure email sent to: nelly_tully@uhc.com  Subject: Jaya Jacob || Longpoint Medical Center || UHC   Hi Nelly!  Medicare ID for Jaya Jacob is 1M3039.  Thanks.', NULL, NULL, '2022-03-08 11:56:11', '2022-03-08 11:56:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(22035, 20067, 21999, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Evening!  Hope you are doing well. Can you please help me out with the credentialing status of the below mentioned 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 Sigi Paul	1033623616 Jaya Jacob	1194336149 Ancy Kurian	1316558935 Jeny John	1073019493   Thank you, Syed Ahad.', NULL, NULL, '2022-03-08 17:42:39', '2022-03-08 17:42:39'),
(22036, 20067, 21999, NULL, '2022-03-22 00:00:00.000', 'Approved', 'hecked status through UHC Portal   Location has been added to provider profille  Effective Date:07/19/2021', NULL, NULL, '2022-03-15 12:10:03', '2022-03-15 12:10:03'),
(22037, 3040, 22000, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:36:58', '2021-03-16 12:36:58'),
(22038, 1006, 22000, NULL, '2021-05-27 00:00:00.000', 'Initiated', 'Provider enrollment request has been submitted via Optum Link. ', NULL, NULL, '2021-05-20 08:34:17', '2021-05-20 08:34:17'),
(22039, 3040, 22000, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to:  networkhelp@uhc.com  Subject: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope you are doing well. I wanted to know enrollment status for the below mentioned provider in our group under the below locations.   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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you', NULL, NULL, '2021-06-08 14:48:33', '2021-06-08 14:48:33'),
(22040, 3040, 22000, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from aldean_mosley@uhc.com  Good morning,  Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed Jacob, Jaya, and  PAUL, SIGI /TAX ID 270796429 regarding enrollment status for provider’s. . Per your provider’s profile, I can confirm that I located a work order request PR-5921427 to add non participating provider’s to group. This work order is not complete, I recommend that you allow more time to complete, you should follow-up in 10 days on PR-5921427.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. If sent to aldean_mosley@uhc.com, it will be considered responded to already and will be deleted.  Have a wonderful day!  Thank You,  Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-06-25 12:03:30', '2021-06-25 12:03:30'),
(22041, 3040, 22000, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Hello,    Hope you are doing well. Please advise the enrollment status for the below mentioned providers in United Healthcare for 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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-06-25 12:04:39', '2021-06-25 12:04:39'),
(22042, 3040, 22000, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in United Healthcare for 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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-15 14:54:43', '2021-07-15 14:54:43'),
(22043, 1006, 22000, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from networkhelp@uhc.com:  Sub: Secure Message from brian_k_autio@uhc.com  \"Good morning,  Thank you for contacting the Network Management Resource Team. Both providers, Jaya Jacob and Sigi Paul, have been linked to the Tax ID 270796429 for Normandy Urgent Care Center, but they are currently not contracted yet. The request, PR-5921427, is still in process to get the group contract loaded. Please allow additional time for the request to get completed.  Please let us know if we can assist further via email. All responses must only be sent to networkhelp@uhc.com, so we don’t receive duplicate emails. Any emails sent to my personal email will be deleted.  If you have any questions or concerns about the content of this email, please do not reply to this email but rather email directly to: networkhelp@uhc.com for further assistance.  Brian K. Autio  Associate Network Contractor United Healthcare Network Management Resource Team (NMRT)  For questions related to credentialing, benefits or claim status, please utilize www.UHCprovider.com or call the United Voice Portal at  877-842-3210.  For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.    For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.  Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation\"', NULL, NULL, '2021-08-03 14:34:36', '2021-08-03 14:34:36'),
(22044, 11056, 22000, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :  networkhelp@uhc.com  Sub : Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Good afternoon!  Hope all is well. This is just a follow up email regarding the enrollment status of below mentioned providers and practice in UHC. Are they contracted now?  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 Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: John, Jeny Provider NPI# : 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 15:29:07', '2021-08-11 15:29:07'),
(22045, 3040, 22000, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from david.c.cliff@optum.com   Provider Name: Jacob, Jaya  A request to add this provider to the group and group contract is in process under PR-6026374 Provider NPI# 1194336149  Provider Name: PAUL, SIGI  A request to add this provider to the group and group contract is in process under PR-6026374 Provider NPI# 1033623616  Provider Name: John, Jeny   A request to add this provider to the group and group contract is in process under PR-6042930 Provider NPI# : 1073019493  *** Please allow more time for these requests to complete ***  David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-08-30 11:16:56', '2021-08-30 11:16:56'),
(22046, 3040, 22000, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || PAUL, SIGI & Jacob, Jaya || UHC ||  Greetings,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below locations.   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 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 3; Provider Name: John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-08-30 11:20:14', '2021-08-30 11:20:14'),
(22047, 3040, 22000, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject:  Secure Message from david.c.cliff@optum.com  Good Afternoon,  Provider Name: Jacob, Jaya  provider was added to the group contract with an effective date of 7/19/2021  The address provided below is not a service location for this provider under this TIN Provider NPI# 1194336149  Provider Name: PAUL, SIGI  Jaya  provider was added to the group contract with an effective date of 7/19/2021  The address provided below is not a service location for this provider under this TIN Provider NPI# 1033623616  Provider Name: John, Jeny  provider has no active contracts loaded under this TIN  The address provided below is not a service location for this provider under this TIN   Provider NPI# : 1073019493  David Cliff UnitedHealthcare Network Management Resource Team (NMRT) ', NULL, NULL, '2021-09-03 10:21:04', '2021-09-03 10:21:04'),
(22048, 10057, 22000, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149  Your earliest response will be highly appreciated. Have a great evening.  Thanks & Regards,', NULL, NULL, '2021-10-14 16:26:27', '2021-10-14 16:26:27'),
(22049, 10057, 22000, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Good Afternoon,  Can I get the latest update on our below mentioned providers enrollment request?  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 14:23:33', '2021-11-23 14:23:33'),
(22050, 10057, 22000, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned request.  Please revert back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-03 16:10:15', '2021-12-03 16:10:15'),
(22051, 10057, 22000, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-10 15:07:26', '2021-12-10 15:07:26'),
(22052, 10057, 22000, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Hope all is well. I just wanted to know the enrollment status for below mentioned providers in UHC in our group under the below location.   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 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com Joseph, Molly 1396380077 â€“ Provider is participating effective 08/23/2021 PAUL, SIGI 1033623616 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com Jacob, Jaya 1194336149 â€“ Not linked to TIN. Send link letter to hpdemo@uhc.com  Thank you.', NULL, NULL, '2021-12-17 13:39:50', '2021-12-17 13:39:50'),
(22053, 10057, 22000, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : hpdemo@uhc.com  Sub : Sigi Paul || Longpoint Medical Center || UHC ||  Please find the attached form.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-23 10:59:00', '2021-12-23 10:59:00'),
(22054, 10057, 22000, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Hello,  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-30 13:20:27', '2021-12-30 13:20:27'),
(22055, 20067, 22000, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status || Longpoint Medical Center || UHC ||  Good afternoon,  Hope you are doing well. I would like to know the enrollment status of the below-mentioned provider under Longpoint Medical Center.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Provider Name	NPI	Location SIGI PAUL	1033623616	9504 LONG POINT RD STE E, Houston,TX 77055-4226 Jaya Jacob	1194336149	9504 LONG POINT RD STE E, Houston,TX 77055-4226  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-06 14:28:11', '2022-01-06 14:28:11'),
(22056, 20067, 22000, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Morning!  Hope this email finds you in good health. Any update on the previous request?  Your early response will be greatly appreciated. Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 09:55:54', '2022-01-18 09:55:54'),
(22057, 20067, 22000, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from:  networkhelpresponse@uhc.com  Sub: Re Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Thank you for contacting the Network Management Resource Team. I have verified credentialing for [Ancy Kurian-] is showing as [ -processing -]. Credentialing approval does not imply or guarantee participation with the health plans. Approved and signed physician contracts are required for participation.( affiliated with group tax id as of 12/22/2021)    If you’re joining a medical group that already has a participation agreement with UnitedHealthcare, you won’t receive a contract directly. Instead, you’ll be added to the group agreement once your credentialing application has been approved. (This can take up to three weeks once credentialing is approved.)    If you are joining a medical group or practice that is wanting to join the network, once the agreement has been approved if you’ve given us an email address, we’ll send you the contract through the secure DocuSign application. If not, we’ll send it to you by U.S. mail.     For more information and resources, please visit https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-contracted.html.     Questions? We’re here to help   If we can further assist you, please respond to this email.     Sincerely,  UnitedHealthcare Network Management Resource Team              Re- Enrollment Status || LPMC || Provider || UHC || Good Morning! Hope this email finds you in good health. Any update on the previous request? Your early response will be greatly appreciated. Thanks and Regards,   This e-mail, including attachments, may include confidential and/or proprietary information, and may be used only by the person or entity to which it is addressed. If the reader of this e-mail is not the intended recipient or intended recipient’s authorized agent, the reader is hereby notified that any dissemination, distribution or copying of this e-mail is prohibited. If you have received this e-mail in error, please notify the sender by replying to this message and delete this e-mail immediately.', NULL, NULL, '2022-01-28 15:08:41', '2022-01-28 15:08:41'),
(22058, 20067, 22000, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Re: Enrollment Status LPMC Provider UHC - [ref:_02678096:ref]   Good afternoon!  Hope this email finds you well. I would like to know the enrollment status of these providers under the below-mentioned TIN#.  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 Ancy Kurian	1316558935 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jeny John	1073019493  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-21 17:57:05', '2022-02-21 17:57:05'),
(22059, 20067, 22000, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: networkhealth@uhc.com, jamie_edmondson@uhc.com  Sub: Re: Enrollment Status || LPMC || Provider || UHC ||  Good Evening!  Hope you are doing well. Can you please help me out with the credentialing status of the below mentioned 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 Sigi Paul	1033623616 Jaya Jacob	1194336149 Ancy Kurian	1316558935 Jeny John	1073019493   Thank you, Syed Ahad.', NULL, NULL, '2022-03-08 17:42:32', '2022-03-08 17:42:32'),
(22060, 20067, 22000, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Secure Email received from: united_healthcare_provider_operations@uhc.com  Sub:  Secure Message from united_healthcare_provider_operations@uhc.com  Good news! We’ve completed the provider/group updates you requested on Dec 17, 2021 6:47:16 PM. Your request was assigned reference number PR-6374197 .  Please see the attached report for details. For your convenience, your original submission is also attached.  If you have questions or need further assistance, please contact your Network Account Manager.  Thank you.  UnitedHealthcare Provider Operations', NULL, NULL, '2022-03-10 10:13:00', '2022-03-10 10:13:00'),
(22061, 20067, 22000, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Checked status through UHC Portal   Location has been added to provider profile. Commercial Plans  Effective Date: 07/19/2021 Community Plan ( Medicaid ) Effective Date: 09/05/2021', NULL, NULL, '2022-03-15 10:19:13', '2022-03-15 10:19:13'),
(22062, 20067, 22000, NULL, '2022-03-22 00:00:00.000', 'Approved', 'Checked status through UHC Portal   Location has been added to provider profile. Commercial Plans  Effective Date: 07/19/2021 Community Plan ( Medicaid ) Effective Date: 09/05/2021', NULL, NULL, '2022-03-15 10:19:15', '2022-03-15 10:19:15'),
(22063, 3046, 22001, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:41:57', '2021-03-16 12:41:57'),
(22064, 1006, 22001, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:31', '2021-04-08 18:14:31'),
(22065, 9057, 22001, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:15:44', '2021-05-25 16:15:44'),
(22066, 9057, 22001, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:26:12', '2021-05-25 16:26:12'),
(22067, 1006, 22001, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:58', '2021-06-11 16:44:58'),
(22068, 1006, 22001, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:30:18', '2021-06-30 09:30:18'),
(22069, 1006, 22001, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:43:14', '2021-08-09 16:43:14'),
(22070, 1006, 22001, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:37', '2021-08-24 14:49:37'),
(22071, 11056, 22001, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:09', '2021-09-21 16:09:09'),
(22072, 11056, 22001, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:21', '2021-10-01 12:50:21'),
(22073, 11056, 22001, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:02', '2021-10-18 15:52:02'),
(22074, 11056, 22001, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:09', '2021-10-26 12:00:09'),
(22075, 11056, 22001, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:35:17', '2021-11-11 14:35:17'),
(22076, 11056, 22001, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:53:16', '2021-12-02 15:53:16'),
(22077, 11056, 22001, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:07:15', '2021-12-16 14:07:15'),
(22078, 11056, 22001, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective date  Patrick Ayarzagoitia  Kingsville - 6/1/2017 Calallen - 6/1/2017 SPID - 6/1/2017   Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 15:26:24', '2021-12-21 15:26:24'),
(22079, 3046, 22002, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:01', '2021-03-16 12:42:01'),
(22080, 1006, 22002, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:35', '2021-04-08 18:14:35'),
(22081, 9057, 22002, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:15:00', '2021-05-25 16:15:00'),
(22082, 1006, 22002, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:55', '2021-06-11 16:44:55'),
(22083, 1006, 22002, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:40:02', '2021-06-30 09:40:02'),
(22084, 1006, 22002, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:43:08', '2021-08-09 16:43:08'),
(22085, 1006, 22002, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:43', '2021-08-24 14:49:43'),
(22086, 11056, 22002, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:19', '2021-09-21 16:09:19'),
(22087, 11056, 22002, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:16', '2021-10-01 12:50:16'),
(22088, 11056, 22002, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:08', '2021-10-18 15:52:08'),
(22089, 11056, 22002, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:24', '2021-10-26 12:00:24'),
(22090, 11056, 22002, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:35:11', '2021-11-11 14:35:11');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(22091, 11056, 22002, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:56:24', '2021-12-02 15:56:24'),
(22092, 11056, 22002, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:07:02', '2021-12-16 14:07:02'),
(22093, 11056, 22002, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider     Effective dates   Juan Miguel Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:45:37', '2021-12-21 13:45:37'),
(22094, 3046, 22003, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:03', '2021-03-16 12:42:03'),
(22095, 1006, 22003, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:39', '2021-04-08 18:14:39'),
(22096, 9057, 22003, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:26:00', '2021-05-25 16:26:00'),
(22097, 1006, 22003, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:52', '2021-06-11 16:44:52'),
(22098, 1006, 22003, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:33:19', '2021-06-30 09:33:19'),
(22099, 1006, 22003, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:43:02', '2021-08-09 16:43:02'),
(22100, 1006, 22003, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:48', '2021-08-24 14:49:48'),
(22101, 11056, 22003, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:27', '2021-09-21 16:09:27'),
(22102, 11056, 22003, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:27', '2021-09-21 16:09:27'),
(22103, 11056, 22003, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:10', '2021-10-01 12:50:10'),
(22104, 11056, 22003, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:13', '2021-10-18 15:52:13'),
(22105, 11056, 22003, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:31', '2021-10-26 12:00:31'),
(22106, 11056, 22003, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:35:06', '2021-11-11 14:35:06'),
(22107, 11056, 22003, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:59:18', '2021-12-02 15:59:18'),
(22108, 11056, 22003, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:06:52', '2021-12-16 14:06:52'),
(22109, 11056, 22003, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Provider       Effective dates   Mari K Capupus   Kingsville - 6/1/2017 CALLALEN - 6/1/2017 STAPLES  - 6/1/2017 SPID     - 6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:35:30', '2021-12-21 13:35:30'),
(22110, 3046, 22004, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:12', '2021-03-16 12:42:12'),
(22111, 1006, 22004, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:43', '2021-04-08 18:14:43'),
(22112, 9057, 22004, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:25:45', '2021-05-25 16:25:45'),
(22113, 9057, 22004, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Dear Sir, We are facing problems while updating data in EMRB as the page setting didn\'t remain the same after adding status and notes. and we have to change the settings after each update', NULL, NULL, '2021-05-25 16:39:37', '2021-05-25 16:39:37'),
(22114, 1006, 22004, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:49', '2021-06-11 16:44:49'),
(22115, 1006, 22004, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:34:23', '2021-06-30 09:34:23'),
(22116, 1006, 22004, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:42:56', '2021-08-09 16:42:56'),
(22117, 1006, 22004, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:51', '2021-08-24 14:49:51'),
(22118, 11056, 22004, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:32', '2021-09-21 16:09:32'),
(22119, 11056, 22004, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:50:03', '2021-10-01 12:50:03'),
(22120, 11056, 22004, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:19', '2021-10-18 15:52:19'),
(22121, 11056, 22004, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:00:38', '2021-10-26 12:00:38'),
(22122, 11056, 22004, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:34:59', '2021-11-11 14:34:59'),
(22123, 11056, 22004, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 15:59:25', '2021-12-02 15:59:25'),
(22124, 11056, 22004, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:06:46', '2021-12-16 14:06:46'),
(22125, 11056, 22004, NULL, '2021-12-30 00:00:00.000', 'In Process', '	 Email sent to: JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope this email finds you well. You haven\'t gotten back to me on this. I am still waiting for the updates on the enrollment updates.  Please respond to me soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-23 16:07:54', '2021-12-23 16:07:54'),
(22126, 19067, 22004, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Hope this email finds you well.  Any updates on the previously mentioned request?  Kindly get back to us once you have time.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-10 17:46:55', '2022-01-10 17:46:55'),
(22127, 19067, 22004, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com, HGBProviderRosters@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  This is my Second Reminder on the request below.  Kindly respond promptly.  Regards, Hammad', NULL, NULL, '2022-01-26 17:35:53', '2022-01-26 17:35:53'),
(22128, 19067, 22004, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email received from: jtrenz@humana.com  Subject: 	RE: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare    Hello!     This is the current status based on my last response to Claims Med Inc.  The information was provided on 12/23/21 and 1/13/22.   ', NULL, NULL, '2022-02-11 16:59:20', '2022-02-11 16:59:20'),
(22129, 19067, 22004, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello!  Can I get the welcome kit for the providers who got affected?  Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-21 17:45:38', '2022-02-21 17:45:38'),
(22130, 19067, 22004, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Subject: Re: Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Hello,  I haven\'t received the welcome letter for the providers. Kindly provide us with the welcome kit.  Thanks, ', NULL, NULL, '2022-03-15 17:57:50', '2022-03-15 17:57:50'),
(22131, 22077, 22004, NULL, '2022-04-15 00:00:00.000', 'In Process', 'Email sent to: CSantiago20@humana.com  Subject: 	Enrollment Query || RHC || Providers || Tricare  Hi,  I would like to know the enrollment process for the following providers with the below-mentioned providers,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary & Billing Location	500 E Caesar, Kingsville, TX 78363 Provider Name	NPI	Location Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	6646 S. Staples St. 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382 Patrick Ayarzagoitia	1649568239	6646 S. Staples St. 122, Corpus Christi, TX 78413 Katherine Rabagos	1134415631	6646 S. Staples St. 122, Corpus Christi, TX 78413 Petina Rogers	1801443916	6646 S. Staples St. 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	6646 S. Staples St. 122, Corpus Christi, TX 78413 Maegan Svatek	1639670250	3817 South Padre Island Drive, Corpus Christi, TX 78415 Maegan Svatek	1639670250	4042 River Hill, Corpus Christi, TX 78410 Traci Mason	1497127831	3817 South Padre Island Drive, Corpus Christi, TX 78415 Traci Mason	1497127831	500 E Caesar, Kingsville, TX 78363  Kindly respond promptly.  Thanks,', NULL, NULL, '2022-04-08 11:09:31', '2022-04-08 11:09:31'),
(22132, 22077, 22004, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Location added through the portal', NULL, NULL, '2022-04-25 08:11:20', '2022-04-25 08:11:20'),
(22133, 3046, 22005, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:42:20', '2021-03-16 12:42:20'),
(22134, 1006, 22005, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:14:46', '2021-04-08 18:14:46'),
(22135, 9057, 22005, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:19:19', '2021-05-25 16:19:19'),
(22136, 1006, 22005, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:47', '2021-06-11 16:44:47'),
(22137, 1006, 22005, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:38:37', '2021-06-30 09:38:37'),
(22138, 1006, 22005, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks. ', NULL, NULL, '2021-08-09 16:42:52', '2021-08-09 16:42:52'),
(22139, 1006, 22005, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:49:55', '2021-08-24 14:49:55'),
(22140, 11056, 22005, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:09:38', '2021-09-21 16:09:38'),
(22141, 11056, 22005, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:49:57', '2021-10-01 12:49:57'),
(22142, 11056, 22005, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:52:24', '2021-10-18 15:52:24');
