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
(48208, 11056, 31657, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Approval Letter received through fax.  Eff date is : 08/16/2021  Please see the attachment.', NULL, NULL, '2021-09-02 15:24:22', '2021-09-02 15:24:22'),
(48209, 1005, 31658, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-30 12:02:20', '2021-06-30 12:02:20'),
(48210, 1005, 31658, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Check the main (Group) Task for details.', NULL, NULL, '2021-06-30 12:05:49', '2021-06-30 12:05:49'),
(48211, 1006, 31658, NULL, '2021-07-09 00:00:00.000', 'In Process', 'The request is in-process in the main group task for reference.', NULL, NULL, '2021-07-02 13:54:43', '2021-07-02 13:54:43'),
(48212, 1006, 31658, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,  I hope you\'re doing well, I just wanted to check in on the status of this request.   Thank you.\"', NULL, NULL, '2021-07-27 17:10:13', '2021-07-27 17:10:13'),
(48213, 1006, 31658, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,   We are still waiting on an update regarding the enrollment status for our group and providers. Please get back to me as soon as possible or please let me know who I should contact regarding this.  Thank you .\"', NULL, NULL, '2021-08-10 17:06:36', '2021-08-10 17:06:36'),
(48214, 1006, 31658, NULL, '2021-08-31 00:00:00.000', 'In Process', 'We received a letter from Friday Healthplans requesting DEA of Dr. Ram, sent them the following email @ providers@fridayhealthplans.com:  Sub: Ramegowda Belakere - Right Step Medical Center  \"Hello,   Please find the updated copy of the DEA for Dr. Ramegowda. Please do let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-24 16:15:29', '2021-08-24 16:15:29'),
(48215, 11056, 31658, NULL, '2021-09-10 00:00:00.000', 'Approved', 'Approval Letter received through fax.  Eff date is : 08/16/2021  Please see the attachment.', NULL, NULL, '2021-09-02 15:23:54', '2021-09-02 15:23:54'),
(48216, 1005, 31659, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-06-30 12:03:02', '2021-06-30 12:03:02'),
(48217, 1005, 31659, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Called (844) 451-4444 and spoke with Gabriel from Credentialing Department. He asked me to share the following details on their email (providers@fridayhealthplans.com). State Name, No of Providers, Tax ID, Locations, Specialty. and they will respond back to us to confirm if they are accepting/need this group.', NULL, NULL, '2021-06-30 12:05:15', '2021-06-30 12:05:15'),
(48218, 1005, 31659, NULL, '2021-07-07 00:00:00.000', 'Initiated', 'Requested submitted to: providers@fridayhealthplans.com  Email sub: Network Participation Request (Right Step Medical Center LLC)  Email body: Hello Gabriel,  As per our discussion today on the phone call below is the requested information for our group including all practicing providers: Group Details: Group Name: Right Step Medical Center LLC Location Address: 11925 Southwest Freeway,Suite 12, Stafford , TX 77477-2300 Tax ID: 85-3252700 Group NPI: 1063008084 Group Specialty: 261QM1300X - Clinic/Center Multi-Specialty Individual Providers Details: Provider Name: Ramegowda, Belakere M.D. NPI:  1235166687 Specialty: 207Q00000X - Family Medicine Provider Name: Glory, Abraham FNP NPI: 1194206490 Specialty: 363LF0000X - Nurse Practitioner Family Provider Name:  Shybi, Varghese FNP NPI: 1285270991 Specialty: 363LF0000X - Nurse Practitioner Family This is a request for this group to become a part of Friday Health Plan as In-Network Provider. Please let me know how to proceed further. Thanks.  ', NULL, NULL, '2021-06-30 12:18:23', '2021-06-30 12:18:23'),
(48219, 1005, 31659, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Response received from: providers@fridayhealthplans.com  Thanks! I will get this information over to my contracting team. Someone should reach out shortly. Please let me know if you need anything else- happy to assist. Have a great day! J  Kodie Barr Provider Operations Specialist Phone: 719-589-3696 Fax: 719-589-4901 fridayhealthplans.com  ', NULL, NULL, '2021-06-30 13:46:04', '2021-06-30 13:46:04'),
(48220, 1006, 31659, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Submitted enrollment request @ Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,   I hope you\'re doing well, please find the attached forms for enrollment of our group and providers. Please let me know if anything else is required to proceed with the enrollment request.   Thank you. \"  Forms are attached for reference. ', NULL, NULL, '2021-07-02 13:54:16', '2021-07-02 13:54:16'),
(48221, 1006, 31659, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,  I hope you\'re doing well, I just wanted to check in on the status of this request.   Thank you.\"', NULL, NULL, '2021-07-27 17:10:07', '2021-07-27 17:10:07'),
(48222, 1006, 31659, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ Teresa White Teresa.White@fridayhealthplans.com:  Sub: Enrollment Request - RSM - Friday Health Plans  \"Hello Teresa,   We are still waiting on an update regarding the enrollment status for our group and providers. Please get back to me as soon as possible or please let me know who I should contact regarding this.  Thank you .\"', NULL, NULL, '2021-08-10 17:06:30', '2021-08-10 17:06:30'),
(48223, 1006, 31659, NULL, '2021-08-31 00:00:00.000', 'In Process', 'We received a letter from Friday Healthplans requesting DEA of Dr. Ram, sent them the following email @ providers@fridayhealthplans.com:  Sub: Ramegowda Belakere - Right Step Medical Center  \"Hello,   Please find the updated copy of the DEA for Dr. Ramegowda. Please do let me know if anything else is required to proceed.  Thank you. \"', NULL, NULL, '2021-08-24 16:15:22', '2021-08-24 16:15:22'),
(48224, 11056, 31659, NULL, '2021-09-10 00:00:00.000', 'In Process', 'Good Afternoon!  Hope this email finds you well. Please inform us with the latest enrollment  status of the following provider and practice soon.  Practice Details :  Practice Name : Right Step Medical Center LLC Practice TIN # : 85-3252700 Practice NPI # : 1063008084 Practice  Address : 11925 Southwest Freeway, Suite 12, Stafford , TX 77477-2300  Provider Details: Provider Name : Belakere, Ramegowda Provider NPI # : 1235166687  If you need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-09-02 15:24:45', '2021-09-02 15:24:45'),
(48225, 11056, 31659, NULL, '2021-09-11 00:00:00.000', 'Approved', 'I have verified the effective date by rep. Kale w. She confirmed the date. Eff date for practice :  08/15/2021  Please see the attachment.', NULL, NULL, '2021-09-03 17:02:21', '2021-09-03 17:02:21'),
(48226, 1006, 31660, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48227, 11056, 31660, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 317694 Application has been submitted and attached.', NULL, NULL, '2021-07-05 12:57:31', '2021-07-05 12:57:31'),
(48228, 3040, 31660, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in BCBS for our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 14:43:13', '2021-07-26 14:43:13'),
(48229, 11056, 31660, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email received from : txproviderupdatesubmission@bcbstx.com   Sub : Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS || : Case Number - 02659064  Good afternoon,  I have located your application and see the provider’s record number for the group has been set up.  Jeny K John Provider record # 8PU638  For any questions regarding network contracting, credentialing, network effective dates or status requests, please contact your network representative. If you do not know who your representative is, please click here and look under Network Management Office Locations - https://www.bcbstx.com/provider/contact_us.html#localnetwork There you will find the phone (local and/or toll free number), fax, and email contact methods.  Thank you,  Network Operations & Solution Delivery Blue Cross Blue Shield of Texas', NULL, NULL, '2021-08-12 17:01:41', '2021-08-12 17:01:41'),
(48230, 3040, 31660, NULL, '2021-08-25 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : NORMANDY URGENT CARE CENTER PA Group Record Id : H00032WN01  Provider Name : JENY K JOHN Provider Record Number : H08PU63801 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	08/17/2021 HMO - Blue Essentials	08/17/2021 BCA - BlueChoice PPO	08/17/2021 SNP - Dual Eligible Special Needs Plan	08/17/2021 HME - Health Select	08/17/2021 MCH - Medicare Advantage HMO	08/17/2021 PMC - Medicare Advantage PPO	08/17/2021 WEL - WellMed MA HMO	08/17/2021', NULL, NULL, '2021-08-18 14:00:31', '2021-08-18 14:00:31'),
(48231, 1006, 31661, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48232, 11056, 31661, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-07-05 09:15:39', '2021-07-05 09:15:39'),
(48233, 1006, 31662, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48234, 11056, 31662, NULL, '2021-07-14 00:00:00.000', 'On Hold', 'Pending due to CAQH issue. Please see the attachment', NULL, NULL, '2021-07-06 16:53:03', '2021-07-06 16:53:03'),
(48235, 3040, 31662, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Jeny John Application no: 12743773 Provider id: 0211248', NULL, NULL, '2021-09-10 14:03:27', '2021-09-10 14:03:27'),
(48236, 12062, 31662, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received Email from CIGNA;  see attached mail for your reference.', NULL, NULL, '2021-09-17 13:20:37', '2021-09-17 13:20:37'),
(48237, 10057, 31662, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Sent To : John.Maguire@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Good Morning,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in Cigna 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  John, Jeny 1073019493  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-08 11:17:21', '2021-11-08 11:17:21'),
(48238, 10057, 31662, NULL, '2021-11-15 00:00:00.000', 'In Process', 'Email Received From : John.Maguire@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Good afternoon Steve,  Unfortunately I don’t have full access to this information in credentialing.  Please call Cigna Provider Services at 1-800-88Cigna (882-4462) for more accurate assistance.  Thank you,  Provider SOLUTIONS & OPERATIONS  John Maguire', NULL, NULL, '2021-11-08 17:12:16', '2021-11-08 17:12:16'),
(48239, 10057, 31662, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Hello,  Hope all is well. I want to get the latest enrollment status on the provider mentioned below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Provider Name	NPI John, Jeny	1073019493  Your early response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 14:50:00', '2021-11-18 14:50:00'),
(48240, 10057, 31662, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Cigna  Hello,  Could you please let me know the update on the below mentioned request as soon as possible?  Thanks & Regards,', NULL, NULL, '2021-12-01 11:47:53', '2021-12-01 11:47:53'),
(48241, 10057, 31662, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : PDMCOGZ@cigna.com  Sub : RE: Completion Notification - Cigna reference ID# W202112012031782  Dear Health Care Professional,  We received your recent request, a copy of which is enclosed. As per your request provider has loaded as specialist & TIN is active in our database ,but address is unavailable  If you have any questions, please send an email to Intake_PDM@cigna.com and include:  Cigna Internal Reference # (W202112012031782)  Name JENY JOHN PID 0211248 effective date 10/20/2021  As per the source document the request has been completed.                                   Regards,  PDM', NULL, NULL, '2021-12-08 09:47:43', '2021-12-08 09:47:43'),
(48242, 10057, 31662, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com  Sub : RE: Completion Notification - Cigna reference ID# W202112012031782  Good Morning,  Hope this email finds you well. I want to know why this mentioned provider Normandy Urgent Care Center location is not showing in the directory yet, However, we have received the effective date.  Name : JENY JOHN  PID : 0211248  Effective date : 10/20/2021  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-12-14 10:43:21', '2021-12-14 10:43:21'),
(48243, 10057, 31662, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & pdmcogz@cigna.com  Sub : RE: Completion Notification - Cigna reference ID# W202112012031782  Greetings!  Can I have an update on the below request. This is my SECOND REMINDER. Please get back to me ASAP!  Regards, Steve Albert', NULL, NULL, '2021-12-20 17:56:02', '2021-12-20 17:56:02'),
(48244, 10057, 31662, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : intake_pdm@cigna.com & pdmcogz@cigna.com  Sub : RE: Completion Notification - Cigna reference ID# W202112012031782  Good Morning,  Any update on my request?  Regards,', NULL, NULL, '2021-12-27 11:00:48', '2021-12-27 11:00:48'),
(48245, 19067, 31662, NULL, '2022-01-21 00:00:00.000', 'Approved', 'Kindly see the attachment.', NULL, NULL, '2022-01-14 18:01:16', '2022-01-14 18:01:16'),
(48246, 1006, 31663, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48247, 11056, 31663, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : 	networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - UNITED HEALTH CARE  Greetings,  I wanted to know how to enroll the below provider in mentioned groups below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  Kindly, respond to me soon. If you have any questions feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 09:32:39', '2021-07-05 09:32:39'),
(48248, 3040, 31663, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Request for participation form sent please see attachment.', NULL, NULL, '2021-07-26 14:44:16', '2021-07-26 14:44:16'),
(48249, 11056, 31663, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon!  Hope all is well. I wanted to know the enrollment status for the below mentioned provider in UHC.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name: 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 14:53:01', '2021-08-11 14:53:01'),
(48250, 3040, 31663, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - UHC  Greetings,   Hope you are doing well. Please provide the enrollment status for the below mentioned providers in UHC in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 2: 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.   Thanks  ', NULL, NULL, '2021-08-30 11:11:56', '2021-08-30 11:11:56'),
(48251, 10057, 31663, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status || Longpoint Medical Center || UHC ||  Good Morning,  Hope this email finds you well. Please provide the enrollment status for the below mentioned provider in UHC in our group under the below two 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  Provider Name	NPI John, Jeny 1073019493  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-22 10:02:16', '2021-10-22 10:02:16'),
(48252, 10057, 31663, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Hello,  Any update on below mentioned request. Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 14:06:57', '2021-11-22 14:06:57'),
(48253, 10057, 31663, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned details.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 14:50:47', '2021-12-02 14:50:47'),
(48254, 10057, 31663, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good Afternoon,  Hope this email finds you well. Please provide the enrollment status for the below mentioned provider in UHC in our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-09 13:08:42', '2021-12-09 13:08:42'),
(48255, 10057, 31663, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Email Received From : networkhelp@uhc.com  Sub : Secure Message from japarker@uhc.com  Greetings,  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.   Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.  Sincerely,  Janice P Associate Network Contractor Provider Operations', NULL, NULL, '2021-12-14 13:06:38', '2021-12-14 13:06:38'),
(48256, 1006, 31664, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48257, 11056, 31664, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:03:09', '2021-07-05 14:03:09'),
(48258, 3040, 31664, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:33', '2021-08-26 08:45:33'),
(48259, 10057, 31664, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:25:45', '2021-10-08 13:25:45'),
(48260, 10057, 31664, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:07:48', '2021-10-21 11:07:48'),
(48261, 10057, 31664, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:44:04', '2021-10-29 09:44:04'),
(48262, 10057, 31664, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:31:32', '2021-11-22 13:31:32'),
(48263, 10057, 31664, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:21:08', '2021-12-02 14:21:08'),
(48264, 10057, 31664, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:49:56', '2021-12-09 11:49:56'),
(48265, 10057, 31664, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:49:35', '2021-12-16 14:49:35'),
(48266, 10057, 31664, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:46:27', '2021-12-22 13:46:27'),
(48267, 10057, 31664, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:01:32', '2021-12-29 12:01:32'),
(48268, 20067, 31664, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:09', '2022-01-12 14:57:09'),
(48269, 20067, 31664, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:55:16', '2022-01-19 09:55:16'),
(48270, 20067, 31664, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: tchpnetworkmanagement@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Syed,     Your PR will be able to assist you with your below request.     Thank you  -Liz', NULL, NULL, '2022-01-28 10:26:09', '2022-01-28 10:26:09'),
(48271, 20067, 31664, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061  Thanks & Regards, Syed Ahad ', NULL, NULL, '2022-03-01 15:26:29', '2022-03-01 15:26:29'),
(48272, 22077, 31664, NULL, '2022-04-25 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Group & Providers || TCHP ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response!  Thanks & Regards.', NULL, NULL, '2022-04-18 11:58:28', '2022-04-18 11:58:28'),
(48273, 1006, 31665, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:28', '2021-07-01 10:25:28'),
(48274, 11056, 31665, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : MDuffee@humana.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Humana  Greetings,  Hope you are doing well. I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 16:03:28', '2021-07-05 16:03:28'),
(48275, 3040, 31665, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Group is enrolled under an ancillary contract, it is attached in main group task for reference.  Eff: 12/01/2012', NULL, NULL, '2021-07-16 16:18:58', '2021-07-16 16:18:58'),
(48276, 1006, 31666, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48277, 11056, 31666, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-07-05 09:40:56', '2021-07-05 09:40:56'),
(48278, 3040, 31666, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:46', '2021-08-25 14:59:46'),
(48279, 3040, 31666, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:56', '2021-09-09 13:07:56'),
(48280, 10057, 31666, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:15:13', '2021-10-18 15:15:13'),
(48281, 10057, 31666, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 12:59:55', '2021-11-11 12:59:55'),
(48282, 10057, 31666, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:47:34', '2021-11-30 10:47:34'),
(48283, 10057, 31666, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:03:05', '2021-12-06 16:03:05'),
(48284, 10057, 31666, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:47:13', '2021-12-13 10:47:13'),
(48285, 10057, 31666, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 13:53:00', '2021-12-20 13:53:00'),
(48286, 10057, 31666, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : latina.small@anthem.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning Latina,  We have send the LOI and group roster to credentialing dept, but no one from that department is responding back to us, its been more than 45 calender days we have send them the LOI and can you please get back to me with an update.  Regards, Alex Credentialing Manager', NULL, NULL, '2021-12-27 09:54:01', '2021-12-27 09:54:01'),
(48287, 10057, 31666, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : latina.small@Amerigroup.com & txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Enrollment Queries || Providers || Amerigroup ||  Good Morning,  You can respond directly to the credentialing  email for assistance with credentialing concerns. I have included them on the email as well.  Thank You in Advance,  Latina Small Provider Experience Consultant Amerigroup, Inc.', NULL, NULL, '2021-12-30 09:21:13', '2021-12-30 09:21:13'),
(48288, 19067, 31666, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Hello!  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 16:02:56', '2022-01-04 16:02:56');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(48289, 20067, 31666, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com & mpswebinquiries@amerigroup.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Groups || AmeriGroup ||   Good Morning! Hope this email finds you well. Any updates on the below-mentioned request?  Thanks and regards, Syed Ahad', NULL, NULL, '2022-01-14 10:48:47', '2022-01-14 10:48:47'),
(48290, 20067, 31666, NULL, '2022-01-31 00:00:00.000', 'Approved', 'Kindly see the attachment of provider Directory  Effective Date: 11/11/2021', NULL, NULL, '2022-01-24 12:39:37', '2022-01-24 12:39:37'),
(48291, 1006, 31667, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48292, 3040, 31667, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:34:00', '2021-07-05 09:34:00'),
(48293, 3040, 31667, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:06', '2021-07-20 10:43:06'),
(48294, 11056, 31667, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:28:08', '2021-08-09 10:28:08'),
(48295, 3040, 31667, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:51', '2021-08-17 13:57:51'),
(48296, 1006, 31668, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48297, 11056, 31668, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-07-05 16:09:30', '2021-07-05 16:09:30'),
(48298, 3040, 31668, NULL, '2021-07-19 00:00:00.000', 'Approved', 'I had a word with First Health and she advised me we have an ancillary contract with Aetna so our group is enrolled with First Health because First Health is the part of Aetna.  ', NULL, NULL, '2021-07-12 16:22:55', '2021-07-12 16:22:55'),
(48299, 1006, 31669, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48300, 11056, 31669, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. Form has been submitted and attached. Kindly see the attachment.', NULL, NULL, '2021-07-05 16:35:32', '2021-07-05 16:35:32'),
(48301, 3040, 31669, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: mdiprsupport@healthsmart.com  Subject: Fw: Provider Application – John  Hi,  We are returning your application due to missing information listed below.  * SSN # * Current state license * Current certificate of Insurance * Explain in Work History * Explain in Employment * Current Release and Attestation date * ALL Disclosure Questions Answered * CAQH not Updated please update CAQH and advise once completed.', NULL, NULL, '2021-07-30 14:33:31', '2021-07-30 14:33:31'),
(48302, 3040, 31669, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Provider Application – John  Hello,   Hope you are doing well. Please note that the provider CAQH updated now you can access the information from CAQH if you need the CAQH access form please let me know.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-30 14:34:18', '2021-07-30 14:34:18'),
(48303, 11056, 31669, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com   &   mdiprsupport@healthsmart.com  Sub : Enrollment Status Query - NUCC - IUVC - Health smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : Joseph, Molly Provider NPI # : 1396380077  Provider Name : John, Jeny Provider NPI # : 1073019493  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:42:27', '2021-08-09 13:42:27'),
(48304, 3040, 31669, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status Query - NUCC - IUVC - Health smart  Hello,   Hope you are doing well. Please advise the enrollment status for the below mentioned provider in Health Smart in our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details: Provider Name : John, Jeny Provider NPI # : 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-08-30 15:06:27', '2021-08-30 15:06:27'),
(48305, 3040, 31669, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email rcvd to: mdiprsupport@healthsmart.com  Subject: Fw: Fw: Enrollment Status Query - NUCC - IUVC - Health smart  Hi,  Provider \'\' John, Jeny NP \'\' is Effective \'\' 10/01/2021 \'\'  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :83345)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-09-01 14:17:36', '2021-09-01 14:17:36'),
(48306, 1006, 31670, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48307, 11056, 31670, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : registrar@multiplan.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC -MULTIPLAN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:37:37', '2021-07-05 13:37:37'),
(48308, 3040, 31670, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:12', '2021-07-06 11:57:12'),
(48309, 3040, 31670, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:05', '2021-07-27 16:42:05'),
(48310, 1006, 31670, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:49', '2021-08-03 10:31:49'),
(48311, 11056, 31670, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:30:53', '2021-08-09 12:30:53'),
(48312, 3040, 31670, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to: appmissinginfo@multiplan.com   Subject: Missing Information || NUCC - IVUC - LPMC || John, Jeny || Multiplan ||  Hello,   Hope you are doing well. I had a word with a Multiplan representative and she requested that the below information is missing in the application.  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 Phone Number: (713) 461-3535 Fax Number: (713) 461-3518  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-23 14:28:55', '2021-08-23 14:28:55'),
(48313, 10057, 31670, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  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 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:48:26', '2021-10-07 16:48:26'),
(48314, 10057, 31670, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:32:54', '2021-11-22 09:32:54'),
(48315, 10057, 31670, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:45:53', '2021-12-02 13:45:53'),
(48316, 10057, 31670, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:14:49', '2021-12-09 11:14:49'),
(48317, 10057, 31670, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:42:15', '2021-12-16 14:42:15'),
(48318, 10057, 31670, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:26:14', '2021-12-22 11:26:14'),
(48319, 10057, 31670, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:55:32', '2021-12-29 11:55:32'),
(48320, 20067, 31670, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:43', '2022-01-12 17:42:43'),
(48321, 20067, 31670, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 16:59:23', '2022-01-18 16:59:23'),
(48322, 20067, 31670, NULL, '2022-02-04 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. See the Attachment Effective Date: 09/30/2021 ', NULL, NULL, '2022-01-28 10:07:05', '2022-01-28 10:07:05'),
(48323, 1006, 31671, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48324, 11056, 31671, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-07-05 13:20:30', '2021-07-05 13:20:30'),
(48325, 1006, 31672, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48326, 11056, 31672, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 09:07:53', '2021-07-05 09:07:53'),
(48327, 11056, 31672, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status : Submitted  PEP Ticket Number : 17907922 ', NULL, NULL, '2021-07-09 11:10:13', '2021-07-09 11:10:13'),
(48328, 11056, 31672, NULL, '2021-08-20 00:00:00.000', 'Approved', ' Portal Ticket #  Application Name  NPI	Status Update Date	Transction Type	Status	   17907922	Jeny-nucc	1073019493	7/28/2021	Enrollment - First Time Applicant	Closed Approved  Please see attachment.', NULL, NULL, '2021-08-13 09:43:26', '2021-08-13 09:43:26'),
(48329, 1006, 31673, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48330, 11056, 31673, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-07-05 14:20:40', '2021-07-05 14:20:40'),
(48331, 3040, 31673, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:07', '2021-07-20 10:52:07'),
(48332, 11056, 31673, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 16:14:32', '2021-08-12 16:14:32'),
(48333, 3040, 31673, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:22', '2021-08-27 10:00:22'),
(48334, 1006, 31674, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48335, 11056, 31674, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 13:30:25', '2021-07-05 13:30:25'),
(48336, 10057, 31674, NULL, '2021-11-26 00:00:00.000', 'Initiated', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon,  Hope you are doing well. We want to enroll the below mentioned provider under given TIN and locations. Please let me know the process.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center  Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jeny John 	1073019493  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-19 17:23:48', '2021-11-19 17:23:48'),
(48337, 10057, 31674, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form and submit with a valid W9.   The form and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-11-24 15:50:36', '2021-11-24 15:50:36'),
(48338, 10057, 31674, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Please find the attached file for your reference. If you require anything else please let me know.  Thanks & Regards,', NULL, NULL, '2021-11-24 15:52:10', '2021-11-24 15:52:10'),
(48339, 10057, 31674, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Hello,  Could you please provide me with the latest update for the below mentioned request.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 13:47:00', '2021-12-01 13:47:00'),
(48340, 10057, 31674, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-08 10:53:42', '2021-12-08 10:53:42'),
(48341, 10057, 31674, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Thank you for the update.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:32:15', '2021-12-14 11:32:15'),
(48342, 10057, 31674, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Any update on the below request?  Regards, Steve Albert', NULL, NULL, '2021-12-21 10:59:09', '2021-12-21 10:59:09'),
(48343, 10057, 31674, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Record # 185307  Provider: Jeny John  Good Afternoon,  Thank you for your inquiry.   The contract request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-27 17:07:15', '2021-12-27 17:07:15'),
(48344, 20067, 31674, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning, Hope all is well with you. Any update on the below mentioned request  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-12 12:10:12', '2022-01-12 12:10:12'),
(48345, 20067, 31674, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from:Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health Good Morning,     The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.      Thank You,', NULL, NULL, '2022-01-12 12:19:42', '2022-01-12 12:19:42'),
(48346, 20067, 31674, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:  Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Hi Michele! Hope you are doing great. Any update on the previous request.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 17:46:28', '2022-01-18 17:46:28'),
(48347, 20067, 31674, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health   Good Morning,    Thank you for your inquiry.   There hasn’t been any updates.  The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.', NULL, NULL, '2022-01-27 18:05:07', '2022-01-27 18:05:07'),
(48348, 20067, 31674, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon!  Hope you are doing well. Any updates for the follow-up?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:20:21', '2022-02-02 16:20:21'),
(48349, 20067, 31674, NULL, '2022-03-03 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@MolinaHealthcare.com  Sub: Molina Provider Contract Update # 187393  Provider:  Jeny John, Jaya Jacob     Good Afternoon,     Please see the attached welcome letter for the above providers.  The providers have been loded in the billing system effective 3/15/2022.  The providers may start seeing Molina members in network effective 3/15/2022.     Thank You,   ', NULL, NULL, '2022-02-24 17:10:00', '2022-02-24 17:10:00'),
(48350, 1006, 31675, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48351, 11056, 31675, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:00:52', '2021-07-05 14:00:52'),
(48352, 20067, 31675, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: NETOPS-ADMIN@centene.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN  Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,  Zujey Ashbaugh (Zuzy)  Contract Coordinator  Network Participation Request related info     Phone Number 866-615-9399', NULL, NULL, '2022-02-16 14:06:49', '2022-02-16 14:06:49'),
(48353, 20067, 31675, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN    Good Afternoon!  Hope this email finds you well. Kindly see the attachment for provider Jeny John.  Thank you,', NULL, NULL, '2022-02-16 14:07:14', '2022-02-16 14:07:14'),
(48354, 20067, 31675, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: ${SECURE}{secure} RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Afternoon!  Hope this email finds you in good condition. I would like to know the enrollment status of the below-mentioned providers. Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jaya Jacob	1194336149 Sigi Paul	1033623616 Jeny John	1073019493  Thank you,', NULL, NULL, '2022-03-02 12:10:55', '2022-03-02 12:10:55'),
(48355, 20067, 31675, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505   Good Afternoon!  Hope this email finds you well. I would like to know the status of the Listed providers with mentioned locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jeny John	1073019493	779 Normandy St Ste 114 Houston , TX 77015-3441 Sigi Paul	1033623616	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Jaya Jacob	1194336149	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Thank you, Syed.', NULL, NULL, '2022-03-18 15:21:28', '2022-03-18 15:21:28'),
(48356, 20067, 31675, NULL, '2022-03-29 00:00:00.000', 'Approved', 'Email received from: txps-coord@superiorhealthplan.com   Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello,     Thank you for contacting Superior Health Plan. Your reference# is R-16163706.     Below is the requested credentialing status under Tax ID  270796429.     Provider Name:  Jeny John  Provider NPI: 1073019493  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Jeny John  Provider NPI: Jeny John  Address: 779 Normandy St Ste 114 Houston , TX 77015-3441  Effective date: 04/01/2022  We do show this address on file for this provider. Please allow up to  30 days to receive a welcome letter.     Provider Name:  Sigi Paul  Provider NPI: 1033623616  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.     Provider Name:  Jaya Jacob  Provider NPI: 1194336149  Address: 16272 IMPERIAL VALLEY DR STE K, Houston , TX 7706  We do not show this address on file for this provider. Should you  have additional questions or concerns, please contact your regional  account manager at AM.Houston@superiorhealthplan.com.', NULL, NULL, '2022-03-22 13:01:26', '2022-03-22 13:01:26'),
(48357, 1006, 31676, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48358, 11056, 31676, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : KMoten4@humana.com  Sub : ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name : Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider: Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:07:45', '2021-07-05 14:07:45'),
(48359, 11056, 31676, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Online Enrollment form has been faxed at (608) 221-7535. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:26:54', '2021-07-09 16:26:54'),
(48360, 11056, 31676, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  This provider below needs to be certified. Please complete that process using the link below:  https://www.humanamilitary.com/provider/access/become-a-tricare-provider/get-certified        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com     TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0', NULL, NULL, '2021-08-11 11:40:35', '2021-08-11 11:40:35'),
(48361, 3040, 31676, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:21', '2021-08-20 14:28:21'),
(48362, 3040, 31676, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:35:58', '2021-08-30 09:35:58'),
(48363, 3040, 31676, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:36:59', '2021-08-30 09:36:59'),
(48364, 10057, 31676, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Any update on the following request?  Thanks & Regards,', NULL, NULL, '2021-10-14 11:32:48', '2021-10-14 11:32:48'),
(48365, 10057, 31676, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Received From : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Steve,  Updates emailed to HGB Roster team can take up to 60 days to process. There is no changed in the status from the email I sent on Tuesday.  Thanks,  Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-11-11 17:25:40', '2021-11-11 17:25:40'),
(48366, 10057, 31676, 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 18:09:31', '2021-11-30 18:09:31'),
(48367, 1006, 31677, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48368, 11056, 31677, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-07-05 14:23:29', '2021-07-05 14:23:29'),
(48369, 3040, 31677, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:03', '2021-07-20 10:36:03'),
(48370, 11056, 31677, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:49:09', '2021-08-11 13:49:09');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(48371, 3040, 31677, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:52', '2021-09-07 16:27:52'),
(48372, 10057, 31677, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:43:09', '2021-10-19 11:43:09'),
(48373, 10057, 31677, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:11:00', '2021-11-22 14:11:00'),
(48374, 10057, 31677, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:06:16', '2021-12-02 15:06:16'),
(48375, 10057, 31677, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:16:15', '2021-12-09 13:16:15'),
(48376, 10057, 31677, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:06:20', '2021-12-17 14:06:20'),
(48377, 10057, 31677, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:16:15', '2021-12-23 11:16:15'),
(48378, 10057, 31677, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:49:55', '2021-12-30 13:49:55'),
(48379, 20067, 31677, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:28:46', '2022-01-06 12:28:46'),
(48380, 20067, 31677, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-11 09:35:21', '2022-01-11 09:35:21'),
(48381, 20067, 31677, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 09:36:46', '2022-01-11 09:36:46'),
(48382, 20067, 31677, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning,     Thank you, we will let you know once provider is complete.     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2022-01-11 12:32:22', '2022-01-11 12:32:22'),
(48383, 20067, 31677, NULL, '2022-01-26 00:00:00.000', 'In Process', '	 Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-19 10:14:00', '2022-01-19 10:14:00'),
(48384, 20067, 31677, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 01/13/2022 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:31:04', '2022-01-20 17:31:04'),
(48385, 1006, 31678, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48386, 11056, 31678, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 13:28:36', '2021-07-05 13:28:36'),
(48387, 3040, 31678, NULL, '2021-07-19 00:00:00.000', 'On Hold', 'Railroad Medicare PTAN Lookup and Request Tool	 Click to Chat Now At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21193000262 ', NULL, NULL, '2021-07-12 09:21:12', '2021-07-12 09:21:12'),
(48388, 1006, 31679, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48389, 1006, 31679, NULL, '2021-07-08 00:00:00.000', 'Initiated', 'Applicant Name: JENY JOHN  Tracking ID: T070120210004902  Submitted Date: THU - JULY 01 2021 05:50:12 PM EST  Submitted By: Jeny John  Contact Email(s): JENYLAIJU@YAHOO.COM NUCC@CLAIMSMEDINC.COM PHOENIXDATA@MSN.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare. ', NULL, NULL, '2021-07-01 16:51:22', '2021-07-01 16:51:22'),
(48390, 3040, 31679, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Jeny John NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1073019493 Individual Provider Transaction Access Number (PTAN): 1R3189 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: June 01, 2021 Changed Information: N/A', NULL, NULL, '2021-07-09 08:39:08', '2021-07-09 08:39:08'),
(48391, 1006, 31680, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:29', '2021-07-01 10:25:29'),
(48392, 3040, 31680, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-07-05 10:01:57', '2021-07-05 10:01:57'),
(48393, 3040, 31680, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:03:45', '2021-07-05 10:03:45'),
(48394, 3040, 31680, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:15', '2021-07-22 10:01:15'),
(48395, 11056, 31680, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:33:20', '2021-08-12 11:33:20'),
(48396, 10057, 31680, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:38:42', '2021-10-08 10:38:42'),
(48397, 10057, 31680, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:22:00', '2021-11-23 17:22:00'),
(48398, 10057, 31680, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:13:48', '2021-12-03 15:13:48'),
(48399, 10057, 31680, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:10:46', '2021-12-10 13:10:46'),
(48400, 10057, 31680, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:46:44', '2021-12-17 10:46:44'),
(48401, 10057, 31680, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:37:49', '2021-12-23 10:37:49'),
(48402, 19067, 31680, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:40:14', '2022-01-04 17:40:14'),
(48403, 20067, 31680, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:27:07', '2022-01-14 15:27:07'),
(48404, 20067, 31680, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:03:58', '2022-01-24 10:03:58'),
(48405, 20067, 31680, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:03:35', '2022-02-02 16:03:35'),
(48406, 20067, 31680, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:07:04', '2022-03-01 15:07:04'),
(48407, 20067, 31680, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:59:56', '2022-03-17 17:59:56'),
(48408, 22077, 31680, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:02:29', '2022-04-15 08:02:29'),
(48409, 22077, 31680, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:15:30', '2022-04-19 13:15:30'),
(48410, 22077, 31680, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:26:54', '2022-04-19 13:26:54'),
(48411, 1006, 31681, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48412, 11056, 31681, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : SWHPEXPEDITES@bswhealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - SCOTT & WHITE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:53:08', '2021-07-05 13:53:08'),
(48413, 11056, 31681, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Thank you again for your request to add a provider to your Scott and White Health Plan contracted group.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 4846e1a0-aeaf-430c-a2d4-7f5718297039  Form has been submitted and attached. Please see the attachment.', NULL, NULL, '2021-07-06 13:45:55', '2021-07-06 13:45:55'),
(48414, 3040, 31681, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Email sent to: SWHPREGION2@bswhealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,    Hope you are doing well. I tried numerous email addresses to get the information regarding enrollment status for the below mentioned group and providers in Scott & White for our group under the below locations. Can you please send me the roster?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Joseph, Molly Provider NPI#   Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-08 09:49:07', '2021-07-08 09:49:07'),
(48415, 3040, 31681, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email rcvd from: SWHPREGION2@bswhealth.org  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello, Below  is a snip it of the locations and plans that the provider(s) in question is contracted for under TIN: 270796429. Please keep in mind that not all provieers listed below are active under TIN 270796429.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 – NOT ACTIVE UNDER TIN 270796429  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - NOT ACTIVE UNDER TIN 270796429  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537- NOT ACTIVE UNDER TIN 270796429  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- NOT ACTIVE UNDER TIN 270796429  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490- NOT ACTIVE UNDER TIN 270796429  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - NOT ACTIVE UNDER TIN 270796429  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - NOT ACTIVE UNDER TIN 270796429  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616- NOT ACTIVE UNDER TIN 270796429  Provider 15:   Provider Name: Joseph, Molly Provider NPI# NOT ACTIVE UNDER TIN 270796429  Provider 16:   Provider Name: John, Jeny Provider NPI# 1396380077 NOT ACTIVE UNDER TIN 270796429  Thanks,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-07-28 16:43:45', '2021-07-28 16:43:45'),
(48416, 11056, 31681, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : SWHPREGION2@bswhealth.org  Sub : Re: Re: FW: Re: Re: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Scott & White ||  Hello,  To add a provider to an already existing contract, you will need to send in a request via online. Below is the link to the form that you will need to fill out and submit.  https://swhp.org/forms/html/add-provider-to-contract-request.html   Thank you,  Jennifer C. Provider Relations Representative', NULL, NULL, '2021-08-09 14:47:40', '2021-08-09 14:47:40'),
(48417, 3040, 31681, NULL, '2021-09-01 00:00:00.000', 'Approved', 'Email rcvd from: SWHPEXPEDITES@bswhealth.org  Subject: To add Joseph, Stephen, Piccione, Paul, Jacob, Fernandus, Chennemkara, Brown, Abraham, Abraham and John to Normandy Urgent Care Center  The provider information for Molly Joseph, Ani Stephen, James Piccione, Sigi Paul, Jaya Jacob, Limy Fernandus, Mini Chennemkara, Brittany Brown, Jeena Abraham, Glory Abraham and Jeny John to be added to Normandy Urgent Care Center has been received and is in process.  He/she has an effective date of 9/7/2021.  However, please allow 3-4 weeks before submitting claims to ensure he/she is completely configured in our system; otherwise, claims may deny.  Note:  For the RightCare (Medicaid) line of business:  If an active/attested TPI is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicaid RightCare Members until one is provided.    For the Medicare line of business: If an active Medicare/PTAN is not provided to us upon submission of the PDF, the Provider will not be set up to see our Medicare Members until one is provided.  Please email the Medicare/TPI once available to:  SWHPEXPEDITES@BSWHealth.org     Thank you and have a great day. Provider Services', NULL, NULL, '2021-08-25 08:44:05', '2021-08-25 08:44:05'),
(48418, 1006, 31682, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48419, 11056, 31682, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Waiting for Medicaid.', NULL, NULL, '2021-07-05 09:39:01', '2021-07-05 09:39:01'),
(48420, 1006, 31683, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48421, 11056, 31683, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : trpndataentry@trpnppo.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - TRPN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 14:41:08', '2021-07-05 14:41:08'),
(48422, 3040, 31683, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Hello,   Hope you are doing well. Please find attached the provider update form to enroll the below mentioned provider in TRPN in our group under the below location.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:52:26', '2021-07-22 16:52:26'),
(48423, 11056, 31683, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to  : 	trpndataentry@trpnppo.com  &   mflores@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned provider under the practice in TRPN.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider Details: Provider Name :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-13 11:54:36', '2021-08-13 11:54:36'),
(48424, 12062, 31683, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent A follow up email;  To:trpndataentry@trpnppo.com;ccampos@trpnppo.com  Subject:RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Dear TRPN Team,  May I have any updated status for below?  ', NULL, NULL, '2021-09-21 15:57:21', '2021-09-21 15:57:21'),
(48425, 12062, 31683, NULL, '2021-10-01 00:00:00.000', 'In Process', 'As per the attached mail received from TRPN, the request is completed .However I replied back for a welcome letter and Effective date.  To:ccampos@trpnppo.com  Subject:RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Dear Campos,  Good Day!  Please provide references such as effective date, plans and onboarding letter for a provider with below details in TRPN network.  ', NULL, NULL, '2021-09-23 16:38:34', '2021-09-23 16:38:34'),
(48426, 10057, 31683, NULL, '2021-11-09 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com & ccampos@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Hello,  Hope you are doing well. I\'m writing this email to check the status and to get the effective date along with the welcome letters as well for the below mentioned provider under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 15:14:04', '2021-11-02 15:14:04'),
(48427, 10057, 31683, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com & ccampos@trpnppo.com  Sub : Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Good Afternoon,  Hope this email finds you in good health. Can I get the latest updates on the below mentioned provider enrollment request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI John, Jeny	1073019493  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:52:22', '2021-11-22 13:52:22'),
(48428, 10057, 31683, NULL, '2021-12-01 00:00:00.000', 'Approved', 'Email Received From : ccampos@trpnppo.com  Sub : RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  This provider is Active, effective date 05/01/2021,  Carlos Campos Data Entry Department Supervisor Three Rivers Provider Network', NULL, NULL, '2021-11-24 13:45:59', '2021-11-24 13:45:59'),
(48429, 1006, 31684, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48430, 11056, 31684, NULL, '2021-07-13 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-07-05 14:18:23', '2021-07-05 14:18:23'),
(48431, 1006, 31685, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48432, 11056, 31685, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS SPOHN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 14:48:02', '2021-07-05 14:48:02');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(48433, 3040, 31685, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:45:01', '2021-07-06 14:45:01'),
(48434, 3040, 31685, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:29', '2021-07-27 16:53:29'),
(48435, 3040, 31685, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:18', '2021-07-28 11:20:18'),
(48436, 1006, 31686, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48437, 11056, 31686, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-07-05 14:53:15', '2021-07-05 14:53:15'),
(48438, 3040, 31686, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:25', '2021-07-22 10:04:25'),
(48439, 11056, 31686, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week.  ', NULL, NULL, '2021-08-09 08:42:14', '2021-08-09 08:42:14'),
(48440, 11056, 31686, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 08:42:35', '2021-08-09 08:42:35'),
(48441, 3040, 31686, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:55:45', '2021-08-17 09:55:45'),
(48442, 10057, 31686, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned groups as we have submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails and let me know the current status of our application.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Please feel free to contact or email me if you have any questions or concerns.  Thanks & Regards,', NULL, NULL, '2021-10-06 15:31:11', '2021-10-06 15:31:11'),
(48443, 10057, 31686, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:17:58', '2021-10-14 11:17:58'),
(48444, 10057, 31686, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 15:05:43', '2021-11-18 15:05:43'),
(48445, 10057, 31686, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:51:46', '2021-12-01 11:51:46'),
(48446, 10057, 31686, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:29:15', '2021-12-08 10:29:15'),
(48447, 10057, 31686, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:05:03', '2021-12-16 11:05:03'),
(48448, 10057, 31686, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:12:51', '2021-12-22 10:12:51'),
(48449, 10057, 31686, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:21:46', '2021-12-29 11:21:46'),
(48450, 19067, 31686, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:24:57', '2022-01-05 11:24:57'),
(48451, 19067, 31686, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:33:47', '2022-01-06 16:33:47'),
(48452, 20067, 31686, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:05:43', '2022-01-14 14:05:43'),
(48453, 20067, 31686, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:35:43', '2022-01-14 14:35:43'),
(48454, 1006, 31687, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48455, 11056, 31687, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : vipproviders@anci-care.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - ANCI CARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:12:19', '2021-07-05 14:12:19'),
(48456, 3040, 31687, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual provider. Please see group task. ', NULL, NULL, '2021-07-13 11:36:15', '2021-07-13 11:36:15'),
(48457, 1006, 31688, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48458, 11056, 31688, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-07-05 14:55:55', '2021-07-05 14:55:55'),
(48459, 3040, 31688, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:04:59', '2021-07-20 11:04:59'),
(48460, 3040, 31688, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:33', '2021-07-22 14:31:33'),
(48461, 1006, 31689, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48462, 11056, 31689, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : providerservices@renaissancefamily.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - RENAISSANCE PHYSICIANS  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:03:20', '2021-07-05 15:03:20'),
(48463, 3040, 31689, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:32', '2021-07-26 12:43:32'),
(48464, 11056, 31689, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:21:59', '2021-08-11 16:21:59'),
(48465, 3040, 31689, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:11:43', '2021-08-18 13:11:43'),
(48466, 1006, 31690, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48467, 11056, 31690, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-07-05 15:36:32', '2021-07-05 15:36:32'),
(48468, 10057, 31690, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:37:01', '2021-12-30 15:37:01'),
(48469, 19067, 31690, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:27:01', '2022-01-05 17:27:01'),
(48470, 20067, 31690, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: rehman@claimsmedinc.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace    Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-06 13:17:36', '2022-01-06 13:17:36'),
(48471, 20067, 31690, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com  Subject: Enrollment || NUCC - IVUC - LPMC || Molina Marketplace   Good afternoon,  Hope you are doing well. I would like to enroll the below-mentioned providers under these locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI John, Jeny	1073019493 Jacob, Jaya	1194336149   I look forward to hearing from you.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 13:20:26', '2022-01-06 13:20:26'),
(48472, 20067, 31690, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:13:03', '2022-01-18 09:13:03'),
(48473, 20067, 31690, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:16:02', '2022-01-28 09:16:02'),
(48474, 20067, 31690, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:29:50', '2022-02-09 15:29:50'),
(48475, 20067, 31690, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:29:03', '2022-02-21 09:29:03'),
(48476, 20067, 31690, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:08:15', '2022-03-01 14:08:15'),
(48477, 20067, 31690, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:10:41', '2022-03-01 14:10:41'),
(48478, 20067, 31690, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:47:26', '2022-03-18 10:47:26'),
(48479, 19067, 31690, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 03/15/2022. See the attachment for the approval letter.', NULL, NULL, '2022-03-30 14:59:55', '2022-03-30 14:59:55'),
(48480, 1006, 31691, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48481, 11056, 31691, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services  Greetings,  I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:41:13', '2021-07-05 15:41:13'),
(48482, 11056, 31691, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services  Dear Ahmed Talha, We\'ve got your ticket! This is a generic response from the Prime Health Services Credentialing ticket system.  We have received your ticket and it has been placed into our queue. Your request has been created with id 161260. The title of the request is : ENROLLMENT REQUEST - NUCC - IVUC - Prime Health Services. Thank you for your patience as we look into your issue. -Prime Health Services Credentialing Team ', NULL, NULL, '2021-07-06 12:59:18', '2021-07-06 12:59:18'),
(48483, 3040, 31691, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:09', '2021-07-22 11:56:09'),
(48484, 11056, 31691, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 09:59:45', '2021-08-12 09:59:45'),
(48485, 11056, 31691, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:11:09', '2021-08-12 10:11:09'),
(48486, 10057, 31691, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Greetings for the day!  Hope you are doing well. I was trying to reach out to know the updated enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations. Also, as per your request please find the attach credentialing application for two highlighted providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI George, Jeemo	1497219067 Stephen, Ani	1588959118 Jose, Julie	1447883061 Brown, Brittany	1275163537 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Joseph, Vibitha	1952931560 Thomas, Cini	1134777238 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 John, Jeny	1073019493 Joseph, Molly	1073019493  Please feel free to reach out to me. Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-07 10:55:34', '2021-10-07 10:55:34'),
(48487, 10057, 31691, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  I\'ve started the credentialing process for providers John and Jose.  I\'ve forwarded your email to the Updates Department (updates@primehealthservices.com ).  They handle effective dates, Tax ID links and locations.  Thank you, Nancy', NULL, NULL, '2021-10-18 14:18:55', '2021-10-18 14:18:55'),
(48488, 10057, 31691, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:14:08', '2021-10-28 15:14:08'),
(48489, 10057, 31691, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:33:14', '2021-11-22 10:33:14'),
(48490, 10057, 31691, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:56:15', '2021-12-02 13:56:15');
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
(48491, 10057, 31691, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:38:49', '2021-12-15 10:38:49'),
(48492, 10057, 31691, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:05:47', '2021-12-22 12:05:47'),
(48493, 10057, 31691, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 15:19:04', '2021-12-29 15:19:04'),
(48494, 20067, 31691, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |   Good afternoon, Hope all is well with you. i would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Abdur Rauf	1497726202 Brittany Brown	1275163537 Vibitha Joseph	1952931560   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:41:55', '2022-01-12 15:41:55'),
(48495, 20067, 31691, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com,  updates@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Evening! Hope you are doing great. Any updates on the below email?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:53:39', '2022-01-18 17:53:39'),
(48496, 20067, 31691, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning!  Hope this email finds you in good health. I would like to know the enrolment status of the below-mentioned providers and if any of them is enrolled kindly send me the welcome kit along with the effective date.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeny John	1407171077	779 Normandy St Ste 114 Houston, TX 77015-3441 Brittany Brown	1275163537	779 Normandy St Ste 114 Houston, TX 77015-3441 Vibitha Joseph	1952931560	779 Normandy St Ste 114 Houston, TX 77015-3441 Group	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:44:21', '2022-01-28 11:44:21'),
(48497, 20067, 31691, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Providers Julie Josie and Jeny John have been credentialed as of 11-23-2021.  This date is for credentialing purposes only and not the effective date.  The Updates Department will respond regarding the effective date, Tax ID link and locations.  Thank you, Nancy', NULL, NULL, '2022-03-02 10:23:01', '2022-03-02 10:23:01'),
(48498, 20067, 31691, NULL, '2022-03-16 00:00:00.000', 'Approved', 'Email received from: patty.albright@primehealthservices.com  Sub: FW: [Fwd: ##RE-168872## : FW: [Fwd: ##RE-168872## : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |]]  Good Afternoon,  All of The providers indicated in your previous email have been added to both locations.  TIN  27-0796429  Julie Jose and Jeny John  Effective date: 11/19/2020     Thanks,', NULL, NULL, '2022-03-09 09:49:19', '2022-03-09 09:49:19'),
(48499, 1006, 31692, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:25:30', '2021-07-01 10:25:30'),
(48500, 11056, 31692, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Greetings,  Hope you are doing well. I wanted to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you! ', NULL, NULL, '2021-07-05 15:53:45', '2021-07-05 15:53:45'),
(48501, 3040, 31692, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:20', '2021-07-19 09:23:20'),
(48502, 3040, 31692, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:05', '2021-07-28 11:39:05'),
(48503, 11056, 31692, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:03:08', '2021-08-11 17:03:08'),
(48504, 3040, 31692, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:02:39', '2021-08-17 15:02:39'),
(48505, 3040, 31692, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:14:38', '2021-09-14 16:14:38'),
(48506, 12062, 31692, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:04:10', '2021-09-22 13:04:10'),
(48507, 10057, 31692, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:28:32', '2021-10-18 16:28:32'),
(48508, 10057, 31692, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can someone please get back to me with an update on our applications for providers, I have attached our group roster, also if there should be any concerned person who will help me out with my queries rather than sending everyone an email for an update, and also our applications are stuck now for way too much time.  If they are completed please provide me with the effective dates and Copy of there Welcome Letters / Contract.  Regards, Alex', NULL, NULL, '2021-11-10 17:40:55', '2021-11-10 17:40:55'),
(48509, 10057, 31692, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good afternoon,  All 3 facilities are awaiting the November Credentials Committee Meeting that is scheduled for November 16, 2021. If you have not received Welcome Letters by December 1st, then please send another email to CHRISTUS.HP.Credentialing@christushealth.org requesting the letters. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254', NULL, NULL, '2021-11-10 17:44:20', '2021-11-10 17:44:20'),
(48510, 10057, 31692, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:38:06', '2021-11-18 13:38:06'),
(48511, 10057, 31692, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:41:10', '2021-12-01 10:41:10'),
(48512, 10057, 31692, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:49:35', '2021-12-14 09:49:35'),
(48513, 10057, 31692, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:34:16', '2021-12-20 13:34:16'),
(48514, 10057, 31692, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:53:54', '2021-12-28 11:53:54'),
(48515, 19067, 31692, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:23:49', '2022-01-04 17:23:49'),
(48516, 19067, 31692, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:32:54', '2022-01-05 11:32:54'),
(48517, 20067, 31692, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:22:58', '2022-01-14 13:22:58'),
(48518, 20067, 31692, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:45:10', '2022-01-21 16:45:10'),
(48519, 20067, 31692, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:03:23', '2022-01-25 17:03:23'),
(48520, 1006, 31693, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48521, 11056, 31693, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Thank you for completing the BCBSTX enrollment. We will notify you once your application has been processed. If you requested to be contracted, please note that your claims may pay out of network for services rendered until your contracts have been accepted, the credentialing process has been completed, and you receive an effective date. Application ID: 317765', NULL, NULL, '2021-07-05 17:08:38', '2021-07-05 17:08:38'),
(48522, 3040, 31693, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tx_standard_contracting_team@bcbstx.com, txproviderupdatesubmission@bcbstx.com, Provider_Relations_Houston@bcbstx.com  Subject: Application ID: 317765 || Longpoint Medical Center || John, Jeny || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Renaissance Physicians for our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 14:39:47', '2021-07-26 14:39:47'),
(48523, 11056, 31693, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : Latrice_Thomas@bcbstx.com  Sub : Re: Application ID: 317694 || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || BCBS || : Case Number - 02659065  Hello Latrice,   Hope you are doing well. Can you please send the effective date for the below mentioned provider because it\'s not mentioned on the roster.   1st Request: Need Effective Date for Normandy Urgent Care & Longpoint Medical Center  Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493  2nd Request: The below location is missing on the roster. I wanted to add the provider in an additional location in BCBS in our group under the below highlighted location.   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1:   Provider Name: John, Jeny Provider NPI# 1073019493 Additional Location:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-12 16:44:26', '2021-08-12 16:44:26'),
(48524, 3040, 31693, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Email sent to: txproviderupdatesubmission@bcbstx.com  Subject: Re: Application ID: 311683 || Longpoint Medical Center || Jacob, Jaya & PAUL, SIGI || BCBS || : Case Number - 02588262  Greetings,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in BCBS in our group under the below location. If the provider is already linked to the below Tax ID, advise the effective date.   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: John, Jeny Provider NPI# 1073019493   Provider 2: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-10 15:06:29', '2021-09-10 15:06:29'),
(48525, 3040, 31693, NULL, '2021-09-21 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : LONG POINT MEDICAL PA Group Record Id : H000429N01  Provider Name : JENY K JOHN Provider Record Number : H08PV47701 Specialty : ANP/CERT/CLNP  Networks : Network Name	Network Effective Date BAV - Blue Advantage HMO	09/15/2021 HMO - Blue Essentials	09/15/2021 HMH - Blue Premier HMO	09/15/2021 BCA - BlueChoice PPO	09/15/2021 SNP - Dual Eligible Special Needs Plan	09/15/2021 HME - Health Select	09/15/2021 MCH - Medicare Advantage HMO	09/15/2021 PMC - Medicare Advantage PPO	09/15/2021 WEL - WellMed MA HMO	09/15/2021 ', NULL, NULL, '2021-09-14 13:20:47', '2021-09-14 13:20:47'),
(48526, 1006, 31694, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48527, 11056, 31694, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.', NULL, NULL, '2021-07-05 09:15:15', '2021-07-05 09:15:15'),
(48528, 1006, 31695, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48529, 11056, 31695, NULL, '2021-07-14 00:00:00.000', 'On Hold', 'Pending due to CAQH issue. Please see the attachment', NULL, NULL, '2021-07-06 16:52:56', '2021-07-06 16:52:56'),
(48530, 3040, 31695, NULL, '2021-09-17 00:00:00.000', 'In Process', 'Jeny John Application no: 12743773 Provider id: 0211248', NULL, NULL, '2021-09-10 11:12:59', '2021-09-10 11:12:59'),
(48531, 12062, 31695, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Received Email from CIGNA;  see attached mail for your reference.', NULL, NULL, '2021-09-17 13:20:14', '2021-09-17 13:20:14'),
(48532, 10057, 31695, NULL, '2021-11-09 00:00:00.000', 'Approved', 'Email Received From : WelcomeHealthCareProvider@cigna.com  Sub : Welcome to the Cigna network  Dear JENY JOHN MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Your effective date is 10/20/2021. Your provider identification number is‍ ‌0211248. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  Please see attachments:', NULL, NULL, '2021-11-02 14:40:45', '2021-11-02 14:40:45'),
(48533, 1006, 31696, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48534, 11056, 31696, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to :   networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - LPMC - UNITED HEALTH CARE  Greetings,  I wanted to know how to enroll the below providers mentioned.  Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# : 76-0612416 Practice NPI# : 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider  Provider Name: John, Jeny Provider NPI# : 1073019493  Kindly, respond to me soon. If you have any questions feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 09:37:12', '2021-07-05 09:37:12'),
(48535, 3040, 31696, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email rcvd from: networkhelp@uhc.com  Subject: Secure Message from aldean_mosley@uhc.com  Thank you for contacting the Network Management Resource Team.  Provider need to be credentialed.  A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/Join-Our-Network/join-get-started.html .   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. Have a wonderful day!  Thank you,  Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-26 14:34:38', '2021-07-26 14:34:38'),
(48536, 11056, 31696, 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 15:28:34', '2021-08-11 15:28:34'),
(48537, 3040, 31696, 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 11:16:55', '2021-08-30 11:16:55'),
(48538, 3040, 31696, 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 11:20:13', '2021-08-30 11:20:13'),
(48539, 3040, 31696, 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 10:21:06', '2021-09-03 10:21:06'),
(48540, 10057, 31696, 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 16:26:03', '2021-10-14 16:26:03'),
(48541, 10057, 31696, 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 14:23:23', '2021-11-23 14:23:23'),
(48542, 10057, 31696, 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 16:10:04', '2021-12-03 16:10:04'),
(48543, 10057, 31696, NULL, '2021-12-16 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, '2021-12-09 13:10:21', '2021-12-09 13:10:21'),
(48544, 10057, 31696, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon,  I want to get the status for LPMC & IVUC locations for Jeny John, since the NUCC locations have already been updated.  Please let me know how long it will take it to update.  Thanks & Regards,', NULL, NULL, '2021-12-16 15:12:20', '2021-12-16 15:12:20'),
(48545, 10057, 31696, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : networkhelp@uhc.com  Sub: Re: Enrollment Status Query - NUCC - IVUC – UHC  Good Morning,   Thank you for contacting the Network Management Resource Team. The provider shows to be linked to TIN 27-0796429 at the listed address; however, the provider is not linked to TIN 76-0612416. Please feel free to submit a request to hpdemo@uhc.com to add the TIN and location.   Please let us know if we can assist further via email.   Thank you, Estrellita “Nikki” Thomas UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-12-22 13:58:33', '2021-12-22 13:58:33'),
(48546, 10057, 31696, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : networkhelp@uhc.com  Sub : Enrollment Status Query - NUCC - IVUC - UHC  Thank you for the update. We will submit the forms for LPMC & IVUC locations.  Regards, Steve Albert', NULL, NULL, '2021-12-29 16:28:38', '2021-12-29 16:28:38'),
(48547, 20067, 31696, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - UHC  Good afternoon, Hope this email finds you well.Any updates on the below mentioned request.  Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:11:46', '2022-01-12 15:11:46'),
(48548, 20067, 31696, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email received from: networkhelpresponse@uhc.com  Sub: Re Enrollment Status Query - NUCC - IVUC - UHC - [ref:_02670681:ref]   Hello,  Jeny John MPIN 7691416 is not credentialed  -         Linked to TIN 270796429  -         Not linked to TIN 760612416  Please update CAQH and initiate credentialing online at https://ncc-optum.secure.force.com/rfp/  Thank you     Re- Enrollment Status Query - NUCC - IVUC - UHC Good afternoon, Hope this email finds you well.Any updates on the below mentioned request. 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, '2022-01-13 09:19:47', '2022-01-13 09:19:47'),
(48549, 20067, 31696, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Email sent to: networkhelpresponse@27s8pfl30fqwgc1t1ivmnoq43eo15cildqeve2dnafevawdimx.5-jldwea4.na123.apex.salesforce.com  Sub: Re: Re Enrollment Status Query - NUCC - IVUC - UHC - [ref:_02670681:ref]   Hope this email finds you in good health. Thanks for the update. For Jeny John NPI: 1073019493  Group Name: Normandy Urgent Care Center Tax ID: 270796429 Group NPI: 1407171077 Location: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Can you provide me with the welcome letter for this location?    Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-13 09:27:52', '2022-01-13 09:27:52'),
(48550, 20067, 31696, NULL, '2022-01-20 00:00:00.000', 'In Process', 'Credentialing initiated for Jeny John through portal for Lonpoint Medical Center. Kindly see the attachment', NULL, NULL, '2022-01-13 09:58:45', '2022-01-13 09:58:45'),
(48551, 20067, 31696, 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 09:56:11', '2022-01-18 09:56:11'),
(48552, 20067, 31696, 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 15:08:35', '2022-01-28 15:08:35'),
(48553, 20067, 31696, 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 17:56:56', '2022-02-21 17:56:56'),
(48554, 20067, 31696, 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 17:42:20', '2022-03-08 17:42:20'),
(48555, 20067, 31696, 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: 09/24/2021 Community Plan ( Medicaid ) Effective Date: 09/24/2021', NULL, NULL, '2022-03-15 10:25:11', '2022-03-15 10:25:11'),
(48556, 1006, 31697, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48557, 11056, 31697, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:03:16', '2021-07-05 14:03:16'),
(48558, 3040, 31697, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:32', '2021-08-26 08:45:32'),
(48559, 10057, 31697, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : kdelam@texaschildrens.org  Sub : Provider Contracts  Hello Elam,  Hope this email finds you well. I\'m writing this email to follow-up against Adil\'s email which was sent to you on 08/25/2021.  For any questions please reach out to me. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:25:35', '2021-10-08 13:25:35'),
(48560, 10057, 31697, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:01:46', '2021-10-21 11:01:46'),
(48561, 10057, 31697, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:46:26', '2021-10-29 09:46:26'),
(48562, 10057, 31697, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:38:26', '2021-11-22 13:38:26'),
(48563, 10057, 31697, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:30:30', '2021-12-02 14:30:30'),
(48564, 10057, 31697, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:53:51', '2021-12-09 11:53:51'),
(48565, 10057, 31697, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:56:35', '2021-12-16 14:56:35'),
(48566, 10057, 31697, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:49:59', '2021-12-22 13:49:59'),
(48567, 10057, 31697, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:20', '2021-12-29 12:04:20');
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
(48568, 20067, 31697, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:57:01', '2022-01-12 14:57:01'),
(48569, 20067, 31697, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:57:45', '2022-01-19 09:57:45'),
(48570, 20067, 31697, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:41:59', '2022-01-28 14:41:59'),
(48571, 1006, 31698, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48572, 11056, 31698, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : humanahoustonpd@humana.com  Sub : ENROLLMENT REQUEST - LPMC - Humana  Greetings,  Hope you are doing well. I wanted to enroll the below provider in the group mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 15:59:48', '2021-07-05 15:59:48'),
(48573, 3040, 31698, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: ENROLLMENT REQUEST - Longpoint Medical Center - John, Jeny - Humana  Hello,   Hope you are doing well. Please find attached the roster as per your previous email requested.   If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 12:10:49', '2021-07-22 12:10:49'),
(48574, 3040, 31698, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: ENROLLMENT REQUEST - Longpoint Medical Center - John, Jeny - Humana  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below provider in Humana in our group under the below location.      Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 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, '2021-08-26 11:16:58', '2021-08-26 11:16:58'),
(48575, 10057, 31698, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Evening,  Hope this email finds you well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Humana in our group under the below location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Stephen, Ani	1588959118 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Joseph, Molly	1073019493  Looking forward to your kind response, Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-10-08 16:28:53', '2021-10-08 16:28:53'),
(48576, 10057, 31698, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  All are loaded and linked to the TIN provided.', NULL, NULL, '2021-11-23 13:47:14', '2021-11-23 13:47:14'),
(48577, 10057, 31698, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Good Afternoon,  Hope you are doing well. Kindly share with me the effective dates along with the welcome letters for all the mentioned provides, also for facility contract / agreement as well.  Please get back to me as soon possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 13:49:00', '2021-11-23 13:49:00'),
(48578, 10057, 31698, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Longpoint Medical Center || Providers || Humana ||  Please see item highlighted in yellow.  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.  Thank you,  HumanaHoustonPD', NULL, NULL, '2021-11-24 10:40:46', '2021-11-24 10:40:46'),
(48579, 10057, 31698, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Need to call on mentioned number in next 15 days.  800-448-6262 or 800-626-2741', NULL, NULL, '2021-12-03 15:34:21', '2021-12-03 15:34:21'),
(48580, 10057, 31698, NULL, '2021-12-17 00:00:00.000', 'Approved', 'Called to check the status - 800-448-6262  Reference for this call : 200015318382 - Rep. Abby  Effective date: 08/26/2021', NULL, NULL, '2021-12-10 13:55:36', '2021-12-10 13:55:36'),
(48581, 1006, 31699, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48582, 11056, 31699, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s approval.', NULL, NULL, '2021-07-05 09:41:03', '2021-07-05 09:41:03'),
(48583, 3040, 31699, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email sent to: mpsweb@amerigroup.com  Subject: Delivery Status Notification (Failure)  Greetings!  Hope you are doing well. I want to inquire about the enrollment status for the below mentioned group and providers in our groups under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details:  Provider 1: Provider name : Thomas, Cini Provider NPI # : 1134777238  Provider 2: Provider name : Stephen, Ani Provider NPI # : 1588959118    Provider 3: Provider name : Rauf., Abdur Provider NPI # : 1407171077  Provider 4: Provider name : Piccione JR, James Provider NPI # : 1356321509  Provider 5: Provider name : PAUL, SIGI Provider NPI # : 1033623616  Provider 6: Provider name : Kourouma , Odette Provider NPI # : 1134525868  Provider 7: Provider name : Joseph, Vibitha Provider NPI # : 1952931560  Provider 8: Provider name : Jose, Julie Provider NPI # : 1447883061  Provider 9: Provider name : Jacob, Jaya Provider NPI # : 1194336149   Provider 10: Provider name : George, Jeemol Provider NPI # : 1497219067  Provider 11: Provider name : Fernandus, Limy Provider NPI # : 1972005189  Provider 12: Provider name : Brown, Brittany Provider NPI # : 1275163537  Provider 13: Provider name : Abraham, Jeena Provider NPI # : 1467901587  Provider 14: Provider name : Abraham, Glory Provider NPI # : 1194206490  Provider 15: Provider name : Chennemkara, Mini Philip Provider NPI # : 1841755956  Provider 16: Provider name : Joseph, Molly Provider NPI # : 1396380077  Provider 17: Provider Name: John, Jeny Provider NPI #  1073019493  If you need any documents or information feel free to reach out to me. Eagerly, waiting for your reply.  Thanks', NULL, NULL, '2021-08-25 14:59:46', '2021-08-25 14:59:46'),
(48584, 3040, 31699, NULL, '2021-09-16 00:00:00.000', 'In Process', 'Email sent to: mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Subject: Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Greetings,   Hope you are doing well. I received an email from your side in which you mentioned that our group &  providers are not contracted with Amerigroup under the below locations besides some of the providers are participating with Amerigroup but not under all the locations. I wanted to know how to enroll and add the additional locations for the below mentioned providers in Amerigroup under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Below are the providers need to enroll in Amerigroup:    Provider Name: Thomas, Cini  NPI: 1134777238  Tax ID: 270796429  Status: Non-Participating  Location: 16272 IMPERIAL VALLEY DR STE K,  Houston     Provider Name: Stephen, Ani  NPI: 1588959118  Tax ID: 270796429  Status: Non-Participating     Provider Name: Piccione JR, James  NPI: 1356321509  Tax ID: 270796429  Status: Non-Participating  Location: 9504 LONG POINT RD STE E  Houston     Provider Name: PAUL, SIGI  NPI: 1033623616  Tax ID: 270796429  Status: Non-Participating     Provider Name: Kourouma , Odette  NPI: 1134525868  Tax ID: 270796429  Status: Non-Participating     Provider/Group Name: Jacob, Jaya  NPI: 1194336149  Status: Non-Participating     Provider Name: Fernandus, Limy  NPI: 1972005189  Status: Non-Participating     Provider Name: Abraham, Jeena  NPI: 1467901587  Provider ID:  Status: Non-Participating     Provider Name: Chennemkara, Mini Philip  NPI: 1841755956  Tax ID: 270796429  Status: Non-Participating     Provider Name: Joseph, Molly  NPI: 1396380077  Status: Non-Participating     Provider Name: John, Jeny  NPI: 1073019493  Tax ID: 27-0796429  Status: Non-Participating     Provider Name: Rauf, Abdur   NPI: 1497726202  Tax ID: 27-0796429  Status: Non-Participating    Request to add the additional location for the below mentioned providers.     Provider Name: Joseph, Vibitha  NPI: 1952931560  Provider ID: 09743760  Tax ID: 760612416  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 9504 LONG POINT RD STE E  Houston  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Provider Name: Abraham, Glory  NPI: 1194206490  Provider ID: 07116206  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Brown, Brittany  NPI: 1275163537  Provider ID: 09808410  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: George, Jeemol  NPI: 1497219067  Provider ID: 09805666  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    Provider Name: Jose, Julie  NPI: 1447883061  Provider ID: 09807037  Tax ID: 270796429  Line of Business: Medicare  Effective Date: 1/1/2021  Status: Participating  Location: 779 Normandy St Ste 114  Houston  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226    If you need any additional information please feel free to call or email me. Please get back to me as soon as you can get a chance. Waiting to hear from you soon.     Thank you ', NULL, NULL, '2021-09-09 13:07:56', '2021-09-09 13:07:56'),
(48585, 10057, 31699, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : mpswebinquiries@amerigroup.com, Jason.Hughes@amerigroup.com, TXCredentialing@amerigroup.com  Sub : Need to Enroll || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || AMERIGROUP ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please get back to me as soon as you get a chance.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-18 15:11:42', '2021-10-18 15:11:42'),
(48586, 10057, 31699, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Hello,  Greetings for the day!  We want to enroll the below mentioned providers on an urgent basis with Amerigroup under below mentioned details. Also please find the attached LOI\'s for all providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me with the update as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-11 13:02:32', '2021-11-11 13:02:32'),
(48587, 10057, 31699, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Greetings!  Can I get the latest update on the below mentioned request.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-30 10:55:06', '2021-11-30 10:55:06'),
(48588, 10057, 31699, NULL, '2021-12-14 00:00:00.000', 'In Process', 'Email Sent To : TXCredentialing@amerigroup.com, Jason.Hughes@amerigroup.com, mpswebinquiries@amerigroup.com  Sub : || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon,  Hope this email finds you in good health. I\'m writing this email to check the status for the applications which we have submitted to enroll the providers with Amerigroup under the TIN\'s.  It is my second follow-up, please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-06 16:11:27', '2021-12-06 16:11:27'),
(48589, 10057, 31699, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Called to check the status: 800 - 600 - 4441  Applications has been received and credentialing started on 11/11/2021. Still need 30 working days to finish the process. Once request will be completed, welcome letter will be issued accordingly.  Call Reference: I145695020 - Representative - Courtney', NULL, NULL, '2021-12-13 10:53:02', '2021-12-13 10:53:02'),
(48590, 10057, 31699, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Please check previous Call Comments.  Will follow-up next week.', NULL, NULL, '2021-12-20 14:03:05', '2021-12-20 14:03:05'),
(48591, 10057, 31699, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Call Details: (800) 600-4441  Rep: Victor  Ref # I146789022  Still in process, need to check next week, also send reminder to below mentioned emails.  latina.small@anthem.com nena.graves@amerigroup.com  Regards, Steve Albert', NULL, NULL, '2021-12-29 11:06:45', '2021-12-29 11:06:45'),
(48592, 20067, 31699, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning, Hope all is well with you. I would like to know the enrollment status of the below-mentioned group and providers and if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Eagerly waiting for your response.   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-10 12:19:33', '2022-01-10 12:19:33'),
(48593, 20067, 31699, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: latina.small@anthem.com  Sub: RE: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning,     Yes, I can look up and confirm the provider(s) status. Please allow me some time to review and respond.     Thank You in Advance,     Latina Small  Provider Experience Consultant  Amerigroup, Inc.', NULL, NULL, '2022-01-11 13:10:32', '2022-01-11 13:10:32'),
(48594, 20067, 31699, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Afternoon Latina and Nena! Hope this email finds you in good health. Haven\'t received any updates from your side. Kindly update me on the previous request.  Eagerly waiting for your response. Thanks & Regards. Syed Ahad', NULL, NULL, '2022-01-19 15:12:49', '2022-01-19 15:12:49'),
(48595, 20067, 31699, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: latina.small@anthem.com, nena.graves@amerigroup.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||  Good Morning!  Eagerly waiting for your response. Kindly respond promptly,  Thank you,', NULL, NULL, '2022-01-28 13:05:17', '2022-01-28 13:05:17'),
(48596, 20067, 31699, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email received from: latina.small@anthem.com  Sub: Re: {EXTERNAL} Re: || URGENT || Need to Enroll || NUCC, IVUC & LPMC || Providers || AMERIGROUP ||   Good Afternoon,     Sincere apologies for any delays. Please see the status for the providers below. If any providers need to be added to the group, please complete the attached LOI and Group App form and return to credentialing with a W9.        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  Amerigroup Status Update  Fernandus, Limy     1972005189  PAR - PR ID 12190801; Effective Date 11/11/2021(Medicaid, Medicare, CHIP)  PAUL, SIGI     1033623616  Non PAR  Jacob, Jaya     1194336149  Non PAR  Abraham, Jeena     1467901587  Non PAR  Thomas, Cini     1134777238  Non PAR  Kourouma , Odette Tiranke     1134525868  Non PAR  Rauf, Abdur     1497726202  PAR – PR ID 10007623; Effective Date 3/1/2012 (Medicaid, Medicare, CHIP, MMP)  Joseph, Molly     1396380077  Non PAR  John, Jeny     1073019493  Non PAR  Stephen, Ani     1588959118  Non PAR  Brown, Brittany     1275163537  Non PAR  Joseph, Vibitha     1952931560  PAR – PR ID 09743760; Effective Date 4/27/2020 (Medicare)  George, Jeemol     1497219067  Non PAR  Jose, Julie     1447883061  Non PAR  Abraham, Glory     1194206490  PAR – PR ID 08200815; Effective Date 10/01/2019 (Medicare)  Chennemkara, Mini Philip     1841755956  Non PAR  Piccione JR, James M     1356321509  Non PAR        Thank You in Advance,     Latina Small, MBA, BSBM', NULL, NULL, '2022-02-08 13:12:39', '2022-02-08 13:12:39'),
(48597, 20067, 31699, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com CC: latina.small@anthem.com  Sub: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Afternoon!  Hope you had a great weekend. Attached are the LOI and Group App for Non-par Providers along with W9.  Kindly let me know if anything else is required from my end.  Regards, ', NULL, NULL, '2022-02-21 13:41:03', '2022-02-21 13:41:03'),
(48598, 20067, 31699, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Secure Email received from:  TX Credentialing  Sub: RE: FW: {EXTERNAL} LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  the LOI has a mix match of the group name with the tax ID.     There is one tax ID listed on the LOI, the group name should correspond to the tax ID.', NULL, NULL, '2022-03-08 09:25:11', '2022-03-08 09:25:11'),
(48599, 20067, 31699, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub:   Good Morning!  Attached are the LOI and Group applications for the providers.  Let me know if anything else is required from my end.  Thank you,', NULL, NULL, '2022-03-08 09:55:26', '2022-03-08 09:55:26'),
(48600, 20067, 31699, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com, latina.small@anthem.com   Sub:  Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Good Morning!  Hope this email finds you in good health. Any updates on the Submitted LOIs of Longpoint Medical Center providers.  Thank you, Syed', NULL, NULL, '2022-03-17 10:02:34', '2022-03-17 10:02:34'),
(48601, 20067, 31699, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email received from: TXCredentialing@amerigroup.com   Sub: FW: {EXTERNAL} Re: LOI and Group App || Longpoint Medical Center || Providers || Amerigroup  Those were received and pending completion.     Check back in 7 business days', NULL, NULL, '2022-03-17 16:41:15', '2022-03-17 16:41:15'),
(48602, 1006, 31700, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48603, 3040, 31700, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'We have an ancillary contract with CHC. Location addition request sent out. For more details please see the group task.  ', NULL, NULL, '2021-07-05 09:32:54', '2021-07-05 09:32:54'),
(48604, 3040, 31700, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Hello Rajika,   Hope you are doing well. Please find the attached signed contract as per your request email for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  If you need any additional information please feel free to call or email me.  Thank you ', NULL, NULL, '2021-07-20 10:43:05', '2021-07-20 10:43:05'),
(48605, 11056, 31700, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : Rajika.Reid@communityhealthchoice.org  Sub : FW: Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || CHC ||  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Community Health Choice for our group under the below locations. And provide us with the updates regarding the signed contract which we have submitted to you in the month of June, 2021.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Practice Name:Longpoint Medical Center Practice Tax ID#  27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-09 10:31:10', '2021-08-09 10:31:10'),
(48606, 3040, 31700, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-08-17 13:57:50', '2021-08-17 13:57:50'),
(48607, 1006, 31701, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:16', '2021-07-01 10:27:16'),
(48608, 11056, 31701, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Aetna\' and Medicaid\'s approval.', NULL, NULL, '2021-07-05 16:09:22', '2021-07-05 16:09:22'),
(48609, 3040, 31701, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please advise me the enrollment status for the below mentioned providers as per your request I sent the information that you requested in your previous email.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main 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: 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 DOB: 04/21/1981 Provider NPI# 1134525868  Provider 11:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   Provider Name: John, Jeny Provider NPI# 1073019493 D.O.B: 06/22/1974  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 15:11:15', '2021-07-09 15:11:15'),
(48610, 3040, 31701, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: MadirajuP@aetna.com  Subject: Re: FW: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello Phani,   Hope you are doing well. Please find the attached email that was sent out to you as per your above email requested on 06/21/2021. Can you please advise the enrollment status for the below mentioned providers in First Health in our group under the below location.   Practice Details: Practice Name: Longpoint Medical Center Practice NPI# 1770763815 Practice TIN# 76-0612416 Main 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: 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: Abraham, Jeena Provider NPI# 1467901587  Provider 12:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 13:   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.   Thanks', NULL, NULL, '2021-08-30 14:04:26', '2021-08-30 14:04:26'),
(48611, 10057, 31701, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Evening,  Hope this email finds you well. I want to inquire about the enrollment status for the below-mentioned providers and practices in First Health.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemol	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Abraham, Jeena	1467901587 John, Jeny	1073019493  Please feel free to reach out to me, if you need any other information. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-11 16:43:50', '2021-10-11 16:43:50'),
(48612, 10057, 31701, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To :MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hi,  Good Evening!  Please find the status of the Providers list attached.  Thank You,  Phani', NULL, NULL, '2021-10-18 10:41:02', '2021-10-18 10:41:02'),
(48613, 10057, 31701, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Thank you for reaching out. As per your given attached file providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more.  If not in a credentialing process then please let me know the process.  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 13:56:50', '2021-11-23 13:56:50'),
(48614, 10057, 31701, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Hello,  Hope this email finds you in good health. Could you please provide me with the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-03 14:54:44', '2021-12-03 14:54:44'),
(48615, 10057, 31701, NULL, '2021-12-20 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  Hope all is well. As per your given attached roster providers not yet credentialed, are they in a credentialing process? If yes, then how long will it take more. If not in a credentialing process then please let me know the process.  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-10 11:36:29', '2021-12-10 11:36:29'),
(48616, 10057, 31701, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Greetings for the day!  Any update on the below request. It is my SECOND REMINDER. Please get back to me ASAP.  Kind Regards, Steve Albert', NULL, NULL, '2021-12-20 13:10:36', '2021-12-20 13:10:36'),
(48617, 10057, 31701, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : MadirajuP@aetna.com  Sub : Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good Morning,  This is my THIRD REMINDER on the below mentioned request.  Your earliest response will be highly appreciated.  Regards,', NULL, NULL, '2021-12-27 11:19:20', '2021-12-27 11:19:20'),
(48618, 20067, 31701, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to:  MadirajuP@aetna.com  Sub: Re: [EXTERNAL] Enrollment Status || Longpoint Medical Center || Group & Providers || First Health ||  Good afternoon, Hope you are doing well. Any updates on the below-mentioned request?  Kindly respond promptly, Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 16:01:06', '2022-01-11 16:01:06'),
(48619, 20067, 31701, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email received from: pccdocsub@mitchell.com  Sub: Document Request [ ref:_00D30cy9._5007V1wTf8a:ref ]   Thank you for your recent call to Provider Customer Service. You are receiving this email because you will be submitting documents for review. To accurately complete our review, please reply to this email (do not forward) and do not change the Subject Line. We can only receive PDF Documents by email. This email has been created specifically for this request and will only be valid for five (5) business days. If a reply has not been received within that time, the case will be closed. This is an automated email program which cannot open password protected emails. If you are unable to send an email that is not password protected, please reach us at one of the numbers below for other options. **This is not a general intake box. Any emails sent to this box, not in response to an active case will not be responded to or worked. ** For additional Questions or concerns please reach us at the following: 800-370-0594 for Gallagher Bassett 800-937-6824 for all other Carriers. Thank you for allowing us to assist with this review.  Network/Product the provider is requesting to be contracted (Auto and/or Workers Comp): Provider full name: first, last (and middle initial if possible) or full entity name if not an individual: FTIN:  NPI number:  Provider Degree:  Provider Specialty:  Address (primary physical office address - no PO Box):  Provider phone number and fax number with area codes:  Provider e-mail Address:  Provider office contact name for follow up:  ref:_00D30cy9._5007V1wTf8a:ref', NULL, NULL, '2022-01-20 10:23:31', '2022-01-20 10:23:31'),
(48620, 20067, 31701, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: pccdocsub@mitchell.com  Sub: Document Request    [ ref:_00D30cy9._5007V1wTf8a:ref ]  Good Morning!  Kindly see the attachments for the document requested. Let me know if anything is required.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-20 10:27:56', '2022-01-20 10:27:56'),
(48621, 20067, 31701, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to:  pccdocsub@mitchell.com,MadirajuP@aetna.com  Sub: Re: Enrollment status || LONGPOINT MEDICAL CENTER || Group & Providers || First Health ||  Good Afternoon!  I would like to know the enrollment 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 Jeny John	1073019493 Molly Joseph	1396380077 SIGI PAUL	1033623616 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Ani Stephen	1588959118 Jeena Abraham	1467901587 Glory Abraham	1194206490 James Piccione JR	1356321509 Mini Chennemkara	1841755956 Odette Korouma	1134525868 Abdur Rauf	1497726202 Jeemol George	1497219067  Thanks & Regards! Syed Ahad.', NULL, NULL, '2022-01-28 14:22:22', '2022-01-28 14:22:22'),
(48622, 20067, 31701, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:10:33', '2022-03-08 17:10:33'),
(48623, 20067, 31701, NULL, '2022-03-15 00:00:00.000', 'On Hold', 'Call First Health at 800-226-5116 spoke to Trina  There are only 4 providers listed under the TIN# 76-0612416.  Before start contracting with First Health, Provider must be credentialed from Aetna.  The contracted providers under this TIN are:  Brittany Brown   EFFECTIVE DATE: 08/01/2020 Provider ID: 3362053 Julie Jose              EFFECTIVE DATE: 08/01/2020 Vibitha Joseph    EFFECTIVE DATE: 08/01/2020  Provider ID: 3362048 Cini Thomas       EFFECTIVE DATE: 01/01/2020  Call Ref# 245941', NULL, NULL, '2022-03-08 17:10:52', '2022-03-08 17:10:52'),
(48624, 1006, 31702, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48625, 11056, 31702, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you. Form has been submitted and attached. Kindly see the attachment.', NULL, NULL, '2021-07-05 16:45:01', '2021-07-05 16:45:01'),
(48626, 11056, 31702, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Health Smart.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 4: Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 6: Provider Name: John, Jeny Provider NPI # : 1073019493  If you have any questions please let me know. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:31:06', '2021-08-09 13:31:06'),
(48627, 3040, 31702, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Re: Fw: Enrollment Status - LPMC - Health Smart  Greetings,  Hope you are doing well. Please find attached demographic update form as per your previous email requested.   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 16:35:44', '2021-08-30 16:35:44'),
(48628, 10057, 31702, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : pr.south@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hello,  Hope this email finds you well. I\'m writing this email to check the status for the below mentioned providers in Health Smart for 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 Chennemkara, Mini Philip	1841755956  Please get back to me as soon as you get a chance. Waiting for your response.  Thanks & Regards,', NULL, NULL, '2021-10-14 15:07:31', '2021-10-14 15:07:31'),
(48629, 10057, 31702, NULL, '2021-11-10 00:00:00.000', 'Approved', 'Email Received From : mdiprsupport@healthsmart.com  Sub : Enrollment Status - LPMC - Health Smart  Hi,  Please see the following Providers with effective dates..  PROVIDER NAME  EFFECTIVE DATE   JOHN, JENY  05/01/2021   JOSEPH, MOLLY  05/01/2021   CHENNEMKARA, MINI P  01/01/2021   Thanks HealthSmart Provider Relations.', NULL, NULL, '2021-11-03 09:28:20', '2021-11-03 09:28:20'),
(48630, 1006, 31703, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48631, 11056, 31703, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to :  registrar@multiplan.com  Sub : ENROLLMENT REQUEST - LPMC -MULTIPLAN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:40:32', '2021-07-05 13:40:32'),
(48632, 3040, 31703, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:11', '2021-07-06 11:57:11'),
(48633, 3040, 31703, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:06', '2021-07-27 16:42:06'),
(48634, 1006, 31703, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:45', '2021-08-03 10:31:45');
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
(48635, 11056, 31703, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:51:00', '2021-08-09 12:51:00'),
(48636, 11056, 31703, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  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# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:52:09', '2021-08-09 12:52:09'),
(48637, 3040, 31703, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to: appmissinginfo@multiplan.com   Subject: Missing Information || NUCC - IVUC - LPMC || John, Jeny || Multiplan ||  Hello,   Hope you are doing well. I had a word with a Multiplan representative and she requested that the below information is missing in the application.  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 Phone Number: (713) 461-3535 Fax Number: (713) 461-3518  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-23 14:29:01', '2021-08-23 14:29:01'),
(48638, 10057, 31703, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  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 Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:48:12', '2021-10-07 16:48:12'),
(48639, 10057, 31703, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:53', '2021-11-22 09:33:53'),
(48640, 10057, 31703, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:47:38', '2021-12-02 13:47:38'),
(48641, 10057, 31703, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:18:30', '2021-12-09 11:18:30'),
(48642, 10057, 31703, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:43:45', '2021-12-16 14:43:45'),
(48643, 10057, 31703, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:49', '2021-12-22 11:27:49'),
(48644, 10057, 31703, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:57:02', '2021-12-29 11:57:02'),
(48645, 20067, 31703, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:37', '2022-01-12 17:42:37'),
(48646, 20067, 31703, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:23', '2022-01-18 17:00:23'),
(48647, 20067, 31703, NULL, '2022-02-04 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. See the Attachment Effective Date: 09/30/2021 ', NULL, NULL, '2022-01-28 10:06:37', '2022-01-28 10:06:37'),
(48648, 1006, 31704, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48649, 11056, 31704, NULL, '2021-07-12 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. See group task.', NULL, NULL, '2021-07-05 13:25:30', '2021-07-05 13:25:30'),
(48650, 1006, 31705, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48651, 11056, 31705, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 09:08:10', '2021-07-05 09:08:10'),
(48652, 11056, 31705, NULL, '2021-07-16 00:00:00.000', 'In Process', 'Enrollment Application Status  Application Status : Submitted  PEP Ticket Number : 17907922', NULL, NULL, '2021-07-09 11:10:30', '2021-07-09 11:10:30'),
(48653, 11056, 31705, NULL, '2021-08-20 00:00:00.000', 'Approved', '	 Portal Ticket #  Application Name  NPI	Status Update Date	Transction Type	Status	   17907922	Jeny-nucc	1073019493	7/28/2021	Enrollment - First Time Applicant	Closed Approved  Please see attachment.', NULL, NULL, '2021-08-13 09:47:21', '2021-08-13 09:47:21'),
(48654, 1006, 31706, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48655, 11056, 31706, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task. ', NULL, NULL, '2021-07-05 14:20:47', '2021-07-05 14:20:47'),
(48656, 3040, 31706, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Longpoint Medical Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below location.    Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:55:06', '2021-07-20 10:55:06'),
(48657, 3040, 31706, NULL, '2021-08-03 00:00:00.000', 'Not Eligible', 'Please see group task. ', NULL, NULL, '2021-07-27 16:14:10', '2021-07-27 16:14:10'),
(48658, 1006, 31707, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48659, 11056, 31707, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 13:30:39', '2021-07-05 13:30:39'),
(48660, 10057, 31707, NULL, '2021-11-26 00:00:00.000', 'Initiated', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Good Afternoon,  Hope you are doing well. We want to enroll the below mentioned provider under given TIN and locations. Please let me know the process.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441 Group Name	Imperial Valley Urgent Care Center  Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Jeny John 	1073019493  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-11-19 17:24:26', '2021-11-19 17:24:26'),
(48661, 10057, 31707, NULL, '2021-11-26 00:00:00.000', 'Initiated', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Good Afternoon,  Hope you are doing well. We want to enroll the below mentioned provider under given details. Please let me know the process.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Primary Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493  Please get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-19 17:25:32', '2021-11-19 17:25:32'),
(48662, 10057, 31707, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form and submit with a valid W9.   The form and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.  Thank You,  Michele Thomas-Martin Associate Specialist, Provider Contracts', NULL, NULL, '2021-11-23 15:32:07', '2021-11-23 15:32:07'),
(48663, 10057, 31707, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : MHTContractrequest@molinahealthcare.com Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Thank you for reaching out. Please find the attached form for your reference.  If you need any thing else please let me know. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-23 15:34:00', '2021-11-23 15:34:00'),
(48664, 10057, 31707, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Hello,  Could you please provide me with the latest updates for the below mentioned request.  Looking forward to your urgent response.  Thanks & Regards,', NULL, NULL, '2021-12-01 13:22:53', '2021-12-01 13:22:53'),
(48665, 10057, 31707, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Received From : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Good Afternoon,  Happy Monday! - Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Extended Family. I have received your application for (| Jeny John ) to contract under TAX ID number (76-0612416).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information below:  HARRIS  Michele Thomas Martin Michele.Thomas-Martin@MolinaHealthcare.com  Best Regards,  Provider Contract Coordination Department | JG ', NULL, NULL, '2021-12-08 11:02:05', '2021-12-08 11:02:05'),
(48666, 10057, 31707, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : MHTContractrequest@molinahealthcare.com Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Thank you for the update. Have a great day!  Regards,', NULL, NULL, '2021-12-14 11:41:40', '2021-12-14 11:41:40'),
(48667, 10057, 31707, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com MHTContractrequest@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Any update on the below request?  Regards, Steve Albert', NULL, NULL, '2021-12-21 11:05:35', '2021-12-21 11:05:35'),
(48668, 10057, 31707, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Record # 185307  Provider: Jeny John  Good Afternoon,  Thank you for your inquiry.   The contract request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-12-27 17:08:27', '2021-12-27 17:08:27'),
(48669, 20067, 31707, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to:  Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health  Good Morning, Hope this email finds you well. Any update for provider Jeny John NPI: 1073019493. Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-12 09:36:46', '2022-01-12 09:36:46'),
(48670, 20067, 31707, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Query || Longpoint Medical Center || Jeny John || Molina Health   Good Morning,     The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.      Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-12 12:05:32', '2022-01-12 12:05:32'),
(48671, 20067, 31707, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Hope this email finds you in good spirits. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 Jeny John	1073019493 Brittany Brown	1275163537  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:58:15', '2022-01-20 10:58:15'),
(48672, 20067, 31707, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the updates below for each provider.     Jeny John -  Please allow a few more weeks for the credentialing application to process.   Once approved the request will be sent for loading in the billing system.     There  is no request on file for the remaining providers under the below TIN.    Please submit a contract request form for both providers if you haven’t already done so.  Please remember to submit an updated W9 with contract request forms and send to MHTContractrequest@Molinahealthcare.com.     Thank You,', NULL, NULL, '2022-01-28 15:25:50', '2022-01-28 15:25:50'),
(48673, 20067, 31707, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Thanks for the update kindly see the attached contract request for both providers.  Thank you, Syed Ahad', NULL, NULL, '2022-02-16 15:18:57', '2022-02-16 15:18:57'),
(48674, 20067, 31707, NULL, '2022-03-10 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Query || NUCC - IVUC || Jeny John || Molina Health  Record # 185307     Provider:  Jeny John     The provider has been added under the Long Point Medical Center location effective 3/15/2022 for all plans.   Please see the attached welcome letter.', NULL, NULL, '2022-03-03 15:31:10', '2022-03-03 15:31:10'),
(48675, 1006, 31708, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48676, 11056, 31708, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicaid\'s enrollment.', NULL, NULL, '2021-07-05 14:00:45', '2021-07-05 14:00:45'),
(48677, 20067, 31708, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: NETOPS-ADMIN@centene.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN  Dear Provider,                    We have received your request to add a provider(s) to your existing contract and we have attached the add provider application to this email for your convenience.  Once complete, please email your application to SHP.NetworkDevelopment@superiorhealthplan.com for processing. Please include only one provider application per email and “Add Provider- Provider Name” in the subject line of the email. This will allow us to keep track of your application and avoid any confusion or delay in having it processed.      To check status of the application, please contact your Provider Relations Representative. To locate your PR rep please use the following link:     http://www.superiorhealthplan.com/contact-us/find-my-provider-representative/        For Re-Credentialing, please email your information to credentialing@centene.com.           Thank you,  Zujey Ashbaugh (Zuzy)  Contract Coordinator  Network Participation Request related info     Phone Number 866-615-9399', NULL, NULL, '2022-02-16 14:06:57', '2022-02-16 14:06:57'),
(48678, 20067, 31708, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN    Good Afternoon!  Hope this email finds you well. Kindly see the attachment for provider Jeny John.  Thank you,', NULL, NULL, '2022-02-16 14:07:20', '2022-02-16 14:07:20'),
(48679, 20067, 31708, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN  Good Afternoon!  Hope you had a great weekend. Are there any updates on the last email?  Eagerly waiting to hear from,  Thank you, ', NULL, NULL, '2022-02-21 14:52:34', '2022-02-21 14:52:34'),
(48680, 20067, 31708, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email received from: shp-networkdevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN   We have not received your credentialing application.  Please resubmit.', NULL, NULL, '2022-03-08 17:18:57', '2022-03-08 17:18:57'),
(48681, 20067, 31708, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: LONG POINT MEDICAL CENTER- ADD PROVIDER JENY JOHN  Kindly see the application for  TIN# 760612416/NPI: 1770763815', NULL, NULL, '2022-03-08 17:21:43', '2022-03-08 17:21:43'),
(48682, 20067, 31708, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Jeny John || LPMC || Superior Health  Good Afternoon!  Hope you are doing well. Attached is the provider packet For Jeny John.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-09 12:38:22', '2022-03-09 12:38:22'),
(48683, 20067, 31708, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Jeny John || LPMC || Superior Health  Hello  We received your completed application on 2/24/2022. Your projected effective date is 4/1/2022. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you,  Leslie Gilchrist  Intake Coordinator  Network Management & Operations', NULL, NULL, '2022-03-10 14:46:31', '2022-03-10 14:46:31'),
(48684, 20067, 31708, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Call Superior Health Plan and spoke to Cynthia Ref# 573330196  Provider Jeny John is In-Network and the Effective Date is 04/01/2022', NULL, NULL, '2022-03-14 15:55:31', '2022-03-14 15:55:31'),
(48685, 19067, 31708, NULL, '2022-04-11 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Subject: JENY JOHN WELCOME LETTER    JENY JOHN  LONG POINT MEDICAL CENTER  LPMC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:    04/01/2022                                                 C/ 61877', NULL, NULL, '2022-04-04 12:28:20', '2022-04-04 12:28:20'),
(48686, 1006, 31709, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48687, 11056, 31709, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : KMoten4@humana.com  Sub : ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name : Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider: Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:07:31', '2021-07-05 14:07:31'),
(48688, 11056, 31709, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Online Enrollment form has been faxed at (608) 221-7535. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:27:16', '2021-07-09 16:27:16'),
(48689, 11056, 31709, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : KMoten4@humana.com  Sub : Secured: RE: ENROLLMENT REQUEST - LPMC - NUCC - IVUC - TRICARE  This provider below needs to be certified. Please complete that process using the link below:  https://www.humanamilitary.com/provider/access/become-a-tricare-provider/get-certified        Respectfully,  Katherine Moten  TRICARE Community Liaison II  Humana  T 502-318-5250  F 210-239-0401  kmoten4@humana.com  HumanaMilitary.com     TRICARE 101 Webinar: https://www.brainshark.com/hgb/vu?pi=zIHzFuMwczRw6Vz0', NULL, NULL, '2021-08-11 11:40:29', '2021-08-11 11:40:29'),
(48690, 3040, 31709, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Hello Yvonne,   Please note that I already sent the provider certification application form through fax for the below mentioned providers. Can you please check and advise?   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-08-20 14:28:22', '2021-08-20 14:28:22'),
(48691, 3040, 31709, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email rcvd from: ywyatt@humana.com  Subject: RE: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon Adil,  You faxed the form to WPS. I do not have visual access to their system to see if an application was received. You may contact WPS at 1 800 444 5445 and ask to speak with the certifications Unit.    Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com', NULL, NULL, '2021-08-30 09:36:00', '2021-08-30 09:36:00'),
(48692, 3040, 31709, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Greetings,  Hope you are doing well. I had a word with (Wyonna) Tricare representative and she advised the application was received for both the below mentioned providers. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:  Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 2:  Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-08-30 09:37:01', '2021-08-30 09:37:01'),
(48693, 10057, 31709, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : ywyatt@humana.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Tricare  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the updated status about our credentialing request. Provider Joseph, Molly is already certified on 08/12/2021 and already in the network but I couldn\'t find the provider on Tricare provider directory. The second provider she requested to send the copy of the state license through fax. But still not yet received any further update from your side.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Joseph, Molly	1073019493 John, Jeny	1073019493  Could you please check and revert back to me. Your early response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-11 14:42:11', '2021-10-11 14:42:11'),
(48694, 10057, 31709, 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 17:23:31', '2021-11-11 17:23:31'),
(48695, 10057, 31709, 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 18:09:00', '2021-11-30 18:09:00'),
(48696, 1006, 31710, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48697, 11056, 31710, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-07-05 14:23:23', '2021-07-05 14:23:23'),
(48698, 3040, 31710, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:32:57', '2021-07-20 10:32:57'),
(48699, 11056, 31710, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:53:13', '2021-08-11 13:53:13'),
(48700, 3040, 31710, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:27:51', '2021-09-07 16:27:51'),
(48701, 10057, 31710, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:47:11', '2021-10-19 11:47:11'),
(48702, 10057, 31710, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  The providers below are PAR effective 5/1/2021. Any provider that is not on this list may need to be submitted to be added via our website or you will need to submit a roster with all pertinent information to have the providers added. If you need to add a location or make demographic changes to a provider please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-11-23 16:16:02', '2021-11-23 16:16:02'),
(48703, 10057, 31710, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-12-02 15:18:44', '2021-12-02 15:18:44'),
(48704, 10057, 31710, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:21:29', '2021-12-09 13:21:29'),
(48705, 10057, 31710, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:00:49', '2021-12-17 14:00:49'),
(48706, 10057, 31710, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:25:01', '2021-12-23 11:25:01'),
(48707, 10057, 31710, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:56:14', '2021-12-30 13:56:14'),
(48708, 20067, 31710, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email Received From: Ashley.Stevens@wellcare.com  Subject: : RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  May I please get the W-9 for :  Longpoint Medical Center  76-0612416    The providers are in the process of being loaded.  Thanks  Ashley Stevens  Contracts Coordinator, Contracting & Network Development   ', NULL, NULL, '2022-01-06 10:52:14', '2022-01-06 10:52:14'),
(48709, 20067, 31710, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Subject: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC    Good morning Ashley,  Kindly see the attachment for Longpoint Medical Center\'s W9.  Thanks and Regards Syed Ahad. ', NULL, NULL, '2022-01-06 11:01:28', '2022-01-06 11:01:28'),
(48710, 20067, 31710, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-11 09:35:13', '2022-01-11 09:35:13'),
(48711, 20067, 31710, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-11 09:36:39', '2022-01-11 09:36:39'),
(48712, 20067, 31710, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email Received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning,     Thank you, we will let you know once provider is complete.     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development', NULL, NULL, '2022-01-11 12:32:08', '2022-01-11 12:32:08'),
(48713, 20067, 31710, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email received from: ashley.stevens@wellcare.com  Sub: RE: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good Afternoon,     All providers are still in progress for all 3 contract, however our credentialing department is asking for a Collaborative form to credential Jeny John 1073019493. Can you provide that for us?     Thanks     Ashley Stevens  Contracts Coordinator, Contracting & Network Development ', NULL, NULL, '2022-01-14 16:59:13', '2022-01-14 16:59:13'),
(48714, 20067, 31710, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good morning Ashley,  Hope you are doing great. Any updates on the previous request?  Thank you, Syed Ahad.', NULL, NULL, '2022-01-25 10:18:53', '2022-01-25 10:18:53'),
(48715, 20067, 31710, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning, I Hope this email finds you well. Kindly see the attachment for Jeny John 1073019493.  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-02-03 14:44:13', '2022-02-03 14:44:13'),
(48716, 20067, 31710, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Sub: Re: FW: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare   Good morning!  Hope this email finds you in good health. Any updates for Jeny John?  Thank you.', NULL, NULL, '2022-02-08 12:03:14', '2022-02-08 12:03:14');
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
(48717, 20067, 31710, NULL, '2022-02-16 00:00:00.000', 'Approved', 'Email received from: ProspectiveProviderTX@wellcare.com  Sub: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,   Jeny John is now active and par for Long Point Medical Center. Please see welcome letter attached.  Effective Date: 01/13/2022', NULL, NULL, '2022-02-09 11:01:15', '2022-02-09 11:01:15'),
(48718, 1006, 31711, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48719, 11056, 31711, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Awaiting Medicare\'s approval.', NULL, NULL, '2021-07-05 13:28:46', '2021-07-05 13:28:46'),
(48720, 3040, 31711, NULL, '2021-07-19 00:00:00.000', 'On Hold', 'Railroad Medicare PTAN Lookup and Request Tool	 Click to Chat Now At this time, we are unable to process your request because one or more of the data elements entered into this tool did not match your local Medicare Administrative Contractor (A/B MAC). If you believe you have received this message in error, please contact your local A/B MAC to validate the accuracy of the provider information you have entered into this tool.  You can locate contact information for your local A/B MAC on the CMS MAC Website List page at https://www.cms.gov/Medicare/Medicare-Contracting/FFSProvCustSvcGen/MAC-Website-List.  Reference Number :	21193000262 ', NULL, NULL, '2021-07-12 09:21:07', '2021-07-12 09:21:07'),
(48721, 1006, 31712, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48722, 1006, 31712, NULL, '2021-07-08 00:00:00.000', 'Initiated', 'Applicant Name: JENY JOHN  Tracking ID: T070120210004902  Submitted Date: THU - JULY 01 2021 05:50:12 PM EST  Submitted By: Jeny John  Contact Email(s): JENYLAIJU@YAHOO.COM NUCC@CLAIMSMEDINC.COM PHOENIXDATA@MSN.COM Reason(s) for submission: A Medicare Part B practitioner is currently enrolled in Medicare and is reassigning his/her benefits to a Part B supplier, Part B practitioner or Part A provider currently enrolled in Medicare. ', NULL, NULL, '2021-07-01 16:51:19', '2021-07-01 16:51:19'),
(48723, 3040, 31712, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Medicare Enrollment Information  Individual Name: Jeny John NP Individual Specialty: NURSE PRACTITIONER Individual National Provider Identifier (NPI): 1073019493 Individual Provider Transaction Access Number (PTAN): 1R3189 Group Legal Business Name (LBN): NORMANDY URGENT CARE CENTER Group NPI: 1407171077 Group PTAN: 396951 Reassignment Effective Date: June 01, 2021 Changed Information: N/A', NULL, NULL, '2021-07-09 08:39:11', '2021-07-09 08:39:11'),
(48724, 1006, 31713, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48725, 11056, 31713, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to :  	Dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - GALAXY HEALTH  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:27:57', '2021-07-05 14:27:57'),
(48726, 11056, 31713, NULL, '2021-07-17 00:00:00.000', 'In Process', 'Email received from :  dmarley@ghn-mci.com  Sub : ENROLLMENT REQUEST - LPMC - Galaxy Health  Hi Ahmed,  Please fax the information for LPMC to 1-800-645-0154 for review.   Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154   The enrollment forms has been faxed at 1-800-645-0154. Kindly see the attachment.', NULL, NULL, '2021-07-09 16:42:05', '2021-07-09 16:42:05'),
(48727, 3040, 31713, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health. ', NULL, NULL, '2021-07-30 14:55:51', '2021-07-30 14:55:51'),
(48728, 11056, 31713, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : dmarley@ghn-mci.com  Sub : LPMC  Good morning Daniel!  Hope you are doing well. Here is the one contract for the group signed by an authorized signatory for the practice and providers mentioned below. Please see the attachment.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you further need any additional information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-12 14:54:53', '2021-08-12 14:54:53'),
(48729, 10057, 31713, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:38:24', '2021-10-08 10:38:24'),
(48730, 10057, 31713, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:26:03', '2021-11-23 17:26:03'),
(48731, 10057, 31713, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:01:09', '2021-12-03 15:01:09'),
(48732, 10057, 31713, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:13:34', '2021-12-10 13:13:34'),
(48733, 10057, 31713, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:49:46', '2021-12-17 10:49:46'),
(48734, 10057, 31713, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:41:17', '2021-12-23 10:41:17'),
(48735, 20067, 31713, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned group and providers.if any of them is enrolled kindly send me their welcome letter.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-11 15:39:08', '2022-01-11 15:39:08'),
(48736, 20067, 31713, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good Morning!  Hope this email finds you in good health. Kindly update me on the previous request which was sent on 01/11/2022.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:41:03', '2022-01-20 10:41:03'),
(48737, 20067, 31713, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health   In regards to Longpoint Medical Center, after review I show the following that is in need of correction for LPMC:     The agreement that was returned to us was signed repeatedly by the same doctor. This doctor did not use their title with the group, such as president, CEO, CFO etc. If this Doctor is indeed an authorized signatory for this group then please submit one contract for the group signed by an authorized signatory for the group using their title with the group.     I also noticed that several of the Credentialing Questionnaires and Amendments etc. look to have been signed using an electronic signature. Please have these physically signed by the actual providers and resubmit those for processing.     Also it appears that several of the Office Data Sheets repeatedly list the same Doctor in the name field instead of additional Doctors. If this is incorrect please correct and resubmit.     The corrections should be faxed to 1-800-645-0154 for review/processing.     Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-01-28 14:30:20', '2022-01-28 14:30:20'),
(48738, 20067, 31713, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Galaxy Health  Good afternoon Daniel!  Hope this email; finds you well, Can you please send me a copy of the agreement and Office Date sheets that need to be resubmitted with corrections.  Thank you,', NULL, NULL, '2022-02-18 13:56:31', '2022-02-18 13:56:31'),
(48739, 20067, 31713, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Call Galaxy Health and spoke to Daniel  We have to send the agreement again so I requested the blank agreement. Once we receive the agreement we\'ll start working on it', NULL, NULL, '2022-03-08 10:15:22', '2022-03-08 10:15:22'),
(48740, 20067, 31713, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Fax the Agreement at 817-633-5729  See the group task', NULL, NULL, '2022-03-08 14:28:53', '2022-03-08 14:28:53'),
(48741, 1006, 31714, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48742, 11056, 31714, NULL, '2021-07-12 00:00:00.000', 'Initiated', 'Email sent to : Jose.Herrera@bswhealth.org  Sub : ENROLLMENT REQUEST - LPMC - SCOTT & WHITE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 13:59:17', '2021-07-05 13:59:17'),
(48743, 11056, 31714, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email received from :  Jose.Herrera@bswhealth.org  Sub : ENROLLMENT REQUEST - LPMC - SCOTT & WHITE  Ahmed,     To add provider to an existing contract, please submit information via the website at:                   https://swhp.org/en-us/prov/provider-account-management#prov-manage-account-forms     thank you,     Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Scott & White Health  7005 Salem Park Drive, Suite 100 | Lubbock, TX 79424  806-784-4306 Office | 254-298-3218 Fax  FirstCare.com', NULL, NULL, '2021-07-06 12:46:08', '2021-07-06 12:46:08'),
(48744, 11056, 31714, NULL, '2021-07-13 00:00:00.000', 'Approved', 'URGENT CARE CONTRACT-LPMC -------------------  Herrera, Jose L Jose.Herrera@bswhealth.org Tue, Nov 17, 8:55 AM (2 days ago) to Martin, me, SWHP  Sherry,  Your TAX ID was contracted as a facility only contract.  We did not credential or load any providers under this contract    We would not have been given any providers to credential or load in our systems under a facility contract.   Thank you,   Jose Herrera  Provider Relations Representative  FirstCare Health Plans—part of Baylor Scott & White Health  1901 W. Loop 289, Suite 9 | Lubbock, TX 79407  806-784-4306 Office | 806-784-4396 Fax  FirstCare.com', NULL, NULL, '2021-07-06 13:30:54', '2021-07-06 13:30:54'),
(48745, 1006, 31715, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48746, 11056, 31715, NULL, '2021-07-12 00:00:00.000', 'On Hold', 'Waiting for Medicaid', NULL, NULL, '2021-07-05 09:39:09', '2021-07-05 09:39:09'),
(48747, 20067, 31715, NULL, '2022-02-10 00:00:00.000', 'In Process', 'Application for adding provider into an existing group has been submitted. See the attachment', NULL, NULL, '2022-02-03 15:38:59', '2022-02-03 15:38:59'),
(48748, 20067, 31715, NULL, '2022-02-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || LPMC || SIGI PAUL & Jeny John || Ambetter ||  Good Evening!  I have submitted the application on 02/03/2022 using the link which you provided for below mentioned providers.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 NPI	Provider 1073019493	Jeny John 1033623616	Sigi Paul  Kindly keep me updated about the application process.  Thank you,', NULL, NULL, '2022-02-17 17:50:35', '2022-02-17 17:50:35'),
(48749, 20067, 31715, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Re: Enrollment Status || LPMC || SIGI PAUL & Jeny John || Ambetter ||  Good Afternoon!  I have submitted the application on 02/03/2022 using the link which you provided for 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 Jeny John	1073019493 Sigi Paul	1033623616 Kindly keep me updated about the application process.  Thank you,', NULL, NULL, '2022-03-04 14:51:14', '2022-03-04 14:51:14'),
(48750, 20067, 31715, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Jeny John || LPMC || Superior Health  Good Afternoon!  Hope you are doing well. Attached is the provider packet For Jeny John.  Thank you, Syed Ahad. ', NULL, NULL, '2022-03-09 12:38:08', '2022-03-09 12:38:08'),
(48751, 20067, 31715, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Jeny John || LPMC || Superior Health  Hello  We received your completed application on 2/24/2022. Your projected effective date is 4/1/2022. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you,  Leslie Gilchrist  Intake Coordinator  Network Management & Operations', NULL, NULL, '2022-03-10 14:46:23', '2022-03-10 14:46:23'),
(48752, 20067, 31715, NULL, '2022-03-29 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: Re: PROVIDER PACKET || Jeny John || LPMC || Superior Health  Hello,  Hope you are doing great. Can you please confirm with me the effective date for provider Jeny John and if the provider is loaded in the system can you please send me the welcome letter.  Thank you, Syed.', NULL, NULL, '2022-03-22 15:11:42', '2022-03-22 15:11:42'),
(48753, 1006, 31716, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48754, 11056, 31716, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to :   trpndataentry@trpnppo.com  Sub : ENROLLMENT REQUEST - LPMC - TRPN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:37:47', '2021-07-05 14:37:47'),
(48755, 3040, 31716, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Enroll Provider || Longpoint Medical Center || John, Jeny || TRPN ||  Hello,   Hope you are doing well. Please find attached the provider update form to enroll the below mentioned provider in TRPN in our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 16:35:38', '2021-07-22 16:35:38'),
(48756, 11056, 31716, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  &  Max Flores   mflores@trpnppo.com  Sub : Fwd: Enroll Provider || Longpoint Medical Center || John, Jeny || TRPN ||  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned provider under the practice in TRPN.  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 :  John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a great weekend! ', NULL, NULL, '2021-08-13 11:49:07', '2021-08-13 11:49:07'),
(48757, 12062, 31716, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Sent A follow up email;  To:trpndataentry@trpnppo.com;ccampos@trpnppo.com  Subject:RE: Enroll Provider || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || John, Jeny || TRPN ||  Dear TRPN Team,  May I have any updated status for below?  ', NULL, NULL, '2021-09-21 15:56:57', '2021-09-21 15:56:57'),
(48758, 10057, 31716, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email Sent To : trpndataentry@trpnppo.com - ccampos@trpnppo.com & mflores@trpnppo.com  Sub : Enroll Provider || Longpoint Medical Center || John, Jeny || TRPN ||  Good Evening,  Hope all is well. I want to inquire about the enrollment status of the below mentioned provider under the practice in TRPN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston  TX 77055-4226  Provider Name	NPI John, Jeny	1073019493  Looking forward to hearing from you soon. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-22 15:09:31', '2021-10-22 15:09:31'),
(48759, 10057, 31716, NULL, '2021-11-05 00:00:00.000', 'Approved', 'Effective Date: 05/01/2021  Please find attachments:', NULL, NULL, '2021-10-29 15:22:47', '2021-10-29 15:22:47'),
(48760, 1006, 31717, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:17', '2021-07-01 10:27:17'),
(48761, 11056, 31717, NULL, '2021-07-13 00:00:00.000', 'Not Eligible', 'Email rcvd from: DHPContracting@dchstx.org, Karla.Claunch@dchstx.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center, Imperial Valley Urgent Care & Longpoint Medical Center || Group & Providers || Driscoll ||  Good morning,  These locations are out of our service area so, we are unable to contract or credential them.  Please see the attached map of our service area.  We will only have members within this area.  If you have any questions, please let me know.  Karla Claunch    ', NULL, NULL, '2021-07-05 14:18:14', '2021-07-05 14:18:14'),
(48762, 1006, 31718, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48763, 11056, 31718, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : 	CSHNproviderrelations@christushealth.org  Sub : ENROLLMENT REQUEST - LPMC - CHRISTUS SPOHN  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:51:00', '2021-07-05 14:51:00'),
(48764, 3040, 31718, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  Greetings,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226     Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:57:36', '2021-07-06 14:57:36'),
(48765, 3040, 31718, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Christus Spohn ||  \"Hello,   We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started, the details are as follows:  Group Name: Longpoint Medical Center NPI# 1770763815 TIN# 76-0612416 Primary Address: 9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you ', NULL, NULL, '2021-07-27 16:48:40', '2021-07-27 16:48:40'),
(48766, 3040, 31718, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:17', '2021-07-28 11:20:17'),
(48767, 1006, 31719, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48768, 11056, 31719, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Awaiting Medicare and Cigna\'s Enrollment.', NULL, NULL, '2021-07-05 14:53:25', '2021-07-05 14:53:25'),
(48769, 3040, 31719, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 10:08:18', '2021-07-22 10:08:18'),
(48770, 11056, 31719, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring |  Adil,  I’ve also forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:56:09', '2021-08-09 09:56:09'),
(48771, 3040, 31719, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I didn\'t get any email from anyone regarding the enrollment. Can you please advise the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 11:31:49', '2021-08-17 11:31:49'),
(48772, 10057, 31719, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon,  Hope this email finds you well, Please be informed that I have not yet received any email from any one, you are therefore requested to please update me about the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned location.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Address	9504 LONG POINT RD STE E Houston , TX 77055-4226  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-06 15:19:01', '2021-10-06 15:19:01'),
(48773, 10057, 31719, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello,  May you reach out to the email listed on the letter of interest? The correct representative will be able to assist you further.  Thank you,  Jennifer Perez', NULL, NULL, '2021-11-09 16:08:44', '2021-11-09 16:08:44'),
(48774, 10057, 31719, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hey,  Can you please share with me the email address of the relevant person.  I truly appreciate your support.  Thanks & Regards,', NULL, NULL, '2021-11-23 17:00:26', '2021-11-23 17:00:26'),
(48775, 10057, 31719, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : JENNIFER.PEREZ@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hi,  Please see below email address.  TXMAContracting@cigna.com  Jennifer Perez Network Operations Senior Analyst | Cigna-Medicare', NULL, NULL, '2021-12-03 14:40:46', '2021-12-03 14:40:46'),
(48776, 10057, 31719, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning,  Hope this email finds you well. I\'m writing this email to check the updated status for the below mentioned providers under the TIN.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-12-10 11:29:06', '2021-12-10 11:29:06'),
(48777, 10057, 31719, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Any update on the below request. This is my second reminder. Please get back to me as soon as possible.  Thanks & Regards, Steve Albert ', NULL, NULL, '2021-12-17 10:36:45', '2021-12-17 10:36:45'),
(48778, 10057, 31719, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good morning,  I\'m still waiting to get an update from your side?  Your earliest response would be appreciated.  Thanks & Regards,', NULL, NULL, '2021-12-23 10:27:47', '2021-12-23 10:27:47'),
(48779, 10057, 31719, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Greetings!  Hope this email finds you well. This is my THIRD REMINDER on the below request, the process is getting deley day by day.  Kindly revert back to me with the latest update.  Regards,', NULL, NULL, '2021-12-29 17:41:35', '2021-12-29 17:41:35'),
(48780, 20067, 31719, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email received from:  TXMAContracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Please fully complete the network interest form for consideration follow the website link below to download the form. Complete for each provider and send it back in and the review process will begin.        1.     TX/OK Cigna Medicare Network  a.     If interested in joining the Cigna Medicare network in the Texas/Oklahoma market, please fill out a Network Interest Form at one of the below links:                                            i.    Practitioner Network Interest Form (Physician/Medical Clinics) – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/practitioner-network-interest-form-tx.pdf     ii. Facility/Ancillary Network Interest Form – https://medicareproviders.cigna.com/static/medicareproviders-cigna-com/docs/facility-network-interest-form-tx.pdf     *** Please ensure all sections are filled out correctly on the forms to prevent any delays on review. ***     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pendings – A representative will reach out if any additional information is needed.        Thank you,  Cigna Medicare', NULL, NULL, '2022-01-11 14:48:11', '2022-01-11 14:48:11'),
(48781, 20067, 31719, NULL, '2022-01-18 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Kindly see the attachments below  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-11 15:09:44', '2022-01-11 15:09:44'),
(48782, 20067, 31719, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon! Hope you are doing well.Haven\'t heard anything from you in the previous email. Kindly respond Promptly.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 15:34:56', '2022-01-19 15:34:56'),
(48783, 20067, 31719, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longmont Medical Center || Group || Cigna Healthspring ||  Good afternoon!  Hope you are doing well, This is my MY SECOND REMINDER Kindly do the needful.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-28 13:44:50', '2022-01-28 13:44:50'),
(48784, 20067, 31719, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Afternoon!  I haven\'t heard from your side yet. Kindly respond to the request it\'s really very urgent.  Thank You.', NULL, NULL, '2022-02-08 13:57:32', '2022-02-08 13:57:32'),
(48785, 20067, 31719, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email received from: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Hello Syed,     The corrected forms were received by you on 1/11/2022. The committee meeting has not met yet for the month, as they are reviewed the following month from when they’re received. Once a decision is made you will be contacted for the next steps.     2.   Network Interest Form  a.     All network interest forms submitted for the current month will be reviewed by the Network Interest Committee the first week of the following month.                                            i.    Example – If we receive an interest form sent on 11/05/2021, the Committee will review the first week of December.  *** Unless a holiday falls within the first week, it will then be reviewed the following week. ***  b.   Please avoid sending in duplicate requests to prevent any issues during the review process.     3.   Status Update  a.     Once the committee has reviewed the forms, you will receive one of the below responses:                                            i.    Approvals – A representative will reach out to initiate contracting and credentialing.                                           ii.    Denials – A letter will be sent to the contact email listed on the Network Interest Form.                                           iii.    Pending’s – A representative will reach out if any additional information is needed.           Thank you,', NULL, NULL, '2022-02-16 15:41:49', '2022-02-16 15:41:49'),
(48786, 20067, 31719, NULL, '2022-03-11 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: RE: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||   Good Evening!  Any updates on the request? Has the committee meeting met?  Kindly update me.  Thank you', NULL, NULL, '2022-03-04 15:55:02', '2022-03-04 15:55:02'),
(48787, 20067, 31719, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: txmacontracting@cigna.com  Sub: Re: [External] Re: Facility/Ancillary Network Interest Form || Longpoint Medical Center || Group || Cigna Healthspring ||  Good Morning!  I have sent the network interest forms on 01/11/2022. Kindly update me on the request.   Thank you,', NULL, NULL, '2022-03-17 10:55:15', '2022-03-17 10:55:15'),
(48788, 1006, 31720, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48789, 11056, 31720, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : 	vipproviders@anci-care.com  Sub : ENROLLMENT REQUEST - LPMC - ANCI CARE  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me. Thank you!', NULL, NULL, '2021-07-05 14:15:36', '2021-07-05 14:15:36'),
(48790, 3040, 31720, NULL, '2021-07-20 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task. ', NULL, NULL, '2021-07-13 13:20:49', '2021-07-13 13:20:49'),
(48791, 1006, 31721, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48792, 11056, 31721, NULL, '2021-07-13 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-07-05 14:55:47', '2021-07-05 14:55:47'),
(48793, 3040, 31721, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Re: Enroll Providers || Longpoint Medical Center || Providers || Triwest ||  Hello Jess,   Hope you are doing well. Can you please advise how to enroll the below mentioned group in Triwest. I already submitted the online application for the group.   Practice Details: Practice Name: Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-20 10:59:59', '2021-07-20 10:59:59'),
(48794, 3040, 31721, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 13:35:35', '2021-07-22 13:35:35'),
(48795, 1006, 31722, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-07-01 10:27:18', '2021-07-01 10:27:18'),
(48796, 11056, 31722, NULL, '2021-07-13 00:00:00.000', 'Initiated', 'Email sent to : providerservices@renaissancefamily.com  Sub : ENROLLMENT REQUEST - LPMC - RENAISSANCE PHYSICIANS  Greetings,  I wanted to know how to enroll the below provider in the groups mentioned below:  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 Provider Name :  John, Jeny Provider NPI# : 1073019493  Kindly respond to me soon. If you need any information feel free to contact me.  Thank you!', NULL, NULL, '2021-07-05 15:00:43', '2021-07-05 15:00:43'),
(48797, 3040, 31722, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com  Subject: Re: [External] Enroll Group & Providers || Longpoint Medical Center || Group & Providers || Renaissance Physicians ||  Hello Chukwuma,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Renaissance Physicians for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 13:06:41', '2021-07-26 13:06:41');
