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
(30414, 1006, 23369, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Katherine is reluctant to share the information of both supervising physicians Luis Leyton-Gonzalez & Rolando Perez and the supervising physicians/MD\'s need to be enrolled before Midlevel/NPs/PAs can be enrolled with Driscoll, so we aren\'t able to proceed with this enrollment.', NULL, NULL, '2021-04-06 15:02:10', '2021-04-06 15:02:10'),
(30415, 1006, 23390, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:34', '2021-03-25 09:25:34'),
(30416, 3040, 23390, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider participating with Healthwest.  ', NULL, NULL, '2021-03-30 10:37:36', '2021-03-30 10:37:36'),
(30417, 1006, 23391, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:35', '2021-03-25 09:25:35'),
(30418, 3040, 23391, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider participating with Healthwest.   Please see attachment  ', NULL, NULL, '2021-03-30 10:53:28', '2021-03-30 10:53:28'),
(30419, 1006, 23392, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:36', '2021-03-25 09:25:36'),
(30420, 3040, 23392, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider participating with Healthwest.   Please see attachment.   ', NULL, NULL, '2021-03-30 10:57:54', '2021-03-30 10:57:54'),
(30421, 1006, 23393, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:37', '2021-03-25 09:25:37'),
(30422, 3040, 23393, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:37:30', '2021-03-30 12:37:30'),
(30423, 9057, 23393, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:35:14', '2021-05-26 13:35:14'),
(30424, 1006, 23393, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:29', '2021-06-11 14:32:29'),
(30425, 1006, 23393, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:03:52', '2021-06-25 11:03:52'),
(30426, 1006, 23394, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:38', '2021-03-25 09:25:38'),
(30427, 3040, 23394, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:40:50', '2021-03-30 12:40:50'),
(30428, 9057, 23394, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:35:34', '2021-05-26 13:35:34'),
(30429, 1006, 23394, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:26', '2021-06-11 14:32:26'),
(30430, 1006, 23394, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:03:49', '2021-06-25 11:03:49'),
(30431, 1006, 23395, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:39', '2021-03-25 09:25:39'),
(30432, 3040, 23395, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider Participating with Healthwest.   Please see attachment ', NULL, NULL, '2021-03-30 11:06:38', '2021-03-30 11:06:38'),
(30433, 1006, 23396, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:40', '2021-03-25 09:25:40'),
(30434, 3040, 23396, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider participating with Healthwest.   Please see attachment. ', NULL, NULL, '2021-03-30 11:11:28', '2021-03-30 11:11:28'),
(30435, 1006, 23397, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:41', '2021-03-25 09:25:41'),
(30436, 3040, 23397, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:39:17', '2021-03-30 12:39:17'),
(30437, 9057, 23397, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:35:43', '2021-05-26 13:35:43'),
(30438, 1006, 23397, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:22', '2021-06-11 14:32:22'),
(30439, 1006, 23397, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:03:47', '2021-06-25 11:03:47'),
(30440, 1006, 23398, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:42', '2021-03-25 09:25:42'),
(30441, 3040, 23398, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Provider participating with Healthwest.   Please see attachment', NULL, NULL, '2021-03-30 12:33:29', '2021-03-30 12:33:29'),
(30442, 1006, 23399, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:25:43', '2021-03-25 09:25:43'),
(30443, 3040, 23399, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:38:28', '2021-03-30 12:38:28'),
(30444, 9057, 23399, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:35:50', '2021-05-26 13:35:50'),
(30445, 1006, 23399, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:19', '2021-06-11 14:32:19'),
(30446, 1006, 23399, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:03:43', '2021-06-25 11:03:43'),
(30447, 3040, 23410, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:50:02', '2021-03-25 09:50:02'),
(30448, 3040, 23410, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 09:52:10', '2021-03-25 09:52:10'),
(30449, 3040, 23410, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application 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, '2021-04-14 14:44:30', '2021-04-14 14:44:30'),
(30450, 3040, 23410, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-05-28 10:47:13', '2021-05-28 10:47:13'),
(30451, 3040, 23410, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:24', '2021-06-16 15:05:24'),
(30452, 3040, 23410, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:39', '2021-06-22 11:47:39'),
(30453, 3040, 23410, NULL, '2021-07-16 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:32', '2021-07-09 12:02:32'),
(30454, 3040, 23410, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:40', '2021-07-20 11:50:40'),
(30455, 3040, 23411, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:53:16', '2021-03-25 09:53:16'),
(30456, 3040, 23411, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you   ', NULL, NULL, '2021-03-25 09:54:03', '2021-03-25 09:54:03'),
(30457, 3040, 23411, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application 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, '2021-04-14 14:42:20', '2021-04-14 14:42:20'),
(30458, 3040, 23411, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-05-28 10:47:17', '2021-05-28 10:47:17'),
(30459, 3040, 23411, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:20', '2021-06-16 15:05:20'),
(30460, 3040, 23411, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:41', '2021-06-22 11:47:41'),
(30461, 3040, 23411, NULL, '2021-07-16 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:36', '2021-07-09 12:02:36'),
(30462, 3040, 23411, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:41', '2021-07-20 11:50:41'),
(30463, 3040, 23412, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:55:02', '2021-03-25 09:55:02'),
(30464, 3040, 23412, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 09:55:44', '2021-03-25 09:55:44'),
(30465, 3040, 23412, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application 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, '2021-04-14 14:34:54', '2021-04-14 14:34:54'),
(30466, 3040, 23412, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-05-28 10:47:21', '2021-05-28 10:47:21'),
(30467, 3040, 23412, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:14', '2021-06-16 15:05:14'),
(30468, 3040, 23412, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:37', '2021-06-22 11:47:37'),
(30469, 3040, 23412, NULL, '2021-07-16 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:38', '2021-07-09 12:02:38'),
(30470, 3040, 23412, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.', NULL, NULL, '2021-07-20 11:50:43', '2021-07-20 11:50:43'),
(30471, 3040, 23413, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 09:56:31', '2021-03-25 09:56:31'),
(30472, 3040, 23413, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. Please find the attached roster to add the practice location in the Humana for our group Valley Med Urgent Care PLLC under below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you  ', NULL, NULL, '2021-03-25 09:56:43', '2021-03-25 09:56:43'),
(30473, 3040, 23413, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana || Greetings,   Hope you are doing well. Please find the attached facility credentialing application 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, '2021-04-14 14:45:15', '2021-04-14 14:45:15'),
(30474, 3040, 23413, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Thank you ', NULL, NULL, '2021-05-28 10:47:25', '2021-05-28 10:47:25'),
(30475, 3040, 23413, NULL, '2021-06-23 00:00:00.000', 'In Process', 'Email rcvd from: stxnm@humana.com  Subject: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Your request was received and is in the queue to be worked.  You will receive an email notification once your request has been completed.  Thank you', NULL, NULL, '2021-06-16 15:05:09', '2021-06-16 15:05:09'),
(30476, 3040, 23413, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com  Subject: Re: Add Location || Group || Valley Med Urgent Care PLLC || Humana ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in Humana for our group Valley Med Urgent Care PLLC under the below location.  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-06-22 11:47:57', '2021-06-22 11:47:57'),
(30477, 3040, 23413, NULL, '2021-07-16 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual providers. We already sent the request for location addition once the location under the contract we gonna update the providers task. ', NULL, NULL, '2021-07-09 12:02:42', '2021-07-09 12:02:42'),
(30478, 3040, 23413, NULL, '2021-07-27 00:00:00.000', 'Approved', '', NULL, NULL, '2021-07-20 11:50:44', '2021-07-20 11:50:44'),
(30479, 1006, 23414, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:32:55', '2021-03-25 10:32:55'),
(30480, 3040, 23414, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:03:12', '2021-03-30 17:03:12'),
(30481, 1006, 23415, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:32:56', '2021-03-25 10:32:56'),
(30482, 3040, 23415, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:02:18', '2021-03-30 17:02:18'),
(30483, 1006, 23416, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:32:57', '2021-03-25 10:32:57'),
(30484, 3040, 23416, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:01:28', '2021-03-30 17:01:28'),
(30485, 1006, 23417, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:32:58', '2021-03-25 10:32:58'),
(30486, 3040, 23417, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:00:54', '2021-03-30 17:00:54'),
(30487, 1006, 23418, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:32:59', '2021-03-25 10:32:59'),
(30488, 3040, 23418, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:00:20', '2021-03-30 17:00:20'),
(30489, 1006, 23419, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:33:00', '2021-03-25 10:33:00'),
(30490, 3040, 23419, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:59:31', '2021-03-30 16:59:31'),
(30491, 1006, 23420, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:33:01', '2021-03-25 10:33:01'),
(30492, 3040, 23420, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:58:50', '2021-03-30 16:58:50'),
(30493, 1006, 23421, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:33:02', '2021-03-25 10:33:02'),
(30494, 3040, 23421, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:58:08', '2021-03-30 16:58:08'),
(30495, 1006, 23422, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:33:03', '2021-03-25 10:33:03'),
(30496, 3040, 23422, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:56:51', '2021-03-30 16:56:51'),
(30497, 1006, 23423, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:33:04', '2021-03-25 10:33:04'),
(30498, 3040, 23423, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:56:08', '2021-03-30 16:56:08'),
(30499, 1006, 23424, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:34:59', '2021-03-25 10:34:59');
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
(30500, 1006, 23424, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:44', '2021-03-26 13:12:44'),
(30501, 1006, 23425, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:00', '2021-03-25 10:35:00'),
(30502, 1006, 23425, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:43', '2021-03-26 13:12:43'),
(30503, 1006, 23426, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:02', '2021-03-25 10:35:02'),
(30504, 1006, 23426, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:42', '2021-03-26 13:12:42'),
(30505, 1006, 23427, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:03', '2021-03-25 10:35:03'),
(30506, 1006, 23427, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:42', '2021-03-26 13:12:42'),
(30507, 1006, 23428, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:14', '2021-03-25 10:35:14'),
(30508, 1006, 23428, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:41', '2021-03-26 13:12:41'),
(30509, 1006, 23429, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:15', '2021-03-25 10:35:15'),
(30510, 1006, 23429, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:41', '2021-03-26 13:12:41'),
(30511, 1006, 23430, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:16', '2021-03-25 10:35:16'),
(30512, 1006, 23430, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:40', '2021-03-26 13:12:40'),
(30513, 1006, 23431, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:17', '2021-03-25 10:35:17'),
(30514, 1006, 23431, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:39', '2021-03-26 13:12:39'),
(30515, 1006, 23432, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:19', '2021-03-25 10:35:19'),
(30516, 1006, 23432, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference. ', NULL, NULL, '2021-03-26 13:12:39', '2021-03-26 13:12:39'),
(30517, 1006, 23433, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:35:45', '2021-03-25 10:35:45'),
(30518, 1006, 23433, NULL, '2021-04-15 00:00:00.000', 'Approved', 'CCN Contract received from Triwest. The group is effective as of 08/10/2020 holding an Ancillary contract.  Contract and welcome letter are attached on group task for reference. ', NULL, NULL, '2021-04-08 18:19:14', '2021-04-08 18:19:14'),
(30519, 1006, 23443, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:29', '2021-03-25 10:40:29'),
(30520, 3040, 23443, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:39:41', '2021-03-31 15:39:41'),
(30521, 1006, 23444, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:30', '2021-03-25 10:40:30'),
(30522, 3040, 23444, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:40:08', '2021-03-31 15:40:08'),
(30523, 1006, 23445, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:31', '2021-03-25 10:40:31'),
(30524, 3040, 23445, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:40:26', '2021-03-31 15:40:26'),
(30525, 1006, 23446, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:32', '2021-03-25 10:40:32'),
(30526, 3040, 23446, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:40:53', '2021-03-31 15:40:53'),
(30527, 1006, 23447, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:34', '2021-03-25 10:40:34'),
(30528, 3040, 23447, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:41:18', '2021-03-31 15:41:18'),
(30529, 1006, 23448, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:35', '2021-03-25 10:40:35'),
(30530, 3040, 23448, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:41:42', '2021-03-31 15:41:42'),
(30531, 1006, 23449, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:36', '2021-03-25 10:40:36'),
(30532, 3040, 23449, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:42:07', '2021-03-31 15:42:07'),
(30533, 1006, 23450, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:37', '2021-03-25 10:40:37'),
(30534, 3040, 23450, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county.', NULL, NULL, '2021-03-31 15:42:35', '2021-03-31 15:42:35'),
(30535, 1006, 23451, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:38', '2021-03-25 10:40:38'),
(30536, 3040, 23451, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county. ', NULL, NULL, '2021-03-31 15:43:15', '2021-03-31 15:43:15'),
(30537, 1006, 23452, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:40:39', '2021-03-25 10:40:39'),
(30538, 3040, 23452, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover Kleberg county. ', NULL, NULL, '2021-03-31 15:43:44', '2021-03-31 15:43:44'),
(30539, 1006, 23453, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:23', '2021-03-25 10:44:23'),
(30540, 1006, 23453, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:25', '2021-03-29 17:32:25'),
(30541, 1006, 23454, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:25', '2021-03-25 10:44:25'),
(30542, 1006, 23454, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:35', '2021-03-29 17:32:35'),
(30543, 1006, 23455, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:26', '2021-03-25 10:44:26'),
(30544, 1006, 23455, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:40', '2021-03-29 17:32:40'),
(30545, 1006, 23456, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:27', '2021-03-25 10:44:27'),
(30546, 1006, 23456, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:47', '2021-03-29 17:32:47'),
(30547, 1006, 23457, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:28', '2021-03-25 10:44:28'),
(30548, 1006, 23457, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:53', '2021-03-29 17:32:53'),
(30549, 1006, 23458, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:30', '2021-03-25 10:44:30'),
(30550, 1006, 23458, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:32:58', '2021-03-29 17:32:58'),
(30551, 1006, 23459, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:31', '2021-03-25 10:44:31'),
(30552, 1006, 23459, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:33:04', '2021-03-29 17:33:04'),
(30553, 1006, 23460, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:32', '2021-03-25 10:44:32'),
(30554, 1006, 23460, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:33:24', '2021-03-29 17:33:24'),
(30555, 1006, 23461, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:33', '2021-03-25 10:44:33'),
(30556, 1006, 23461, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:33:30', '2021-03-29 17:33:30'),
(30557, 1006, 23462, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:35', '2021-03-25 10:44:35'),
(30558, 1006, 23462, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:33:37', '2021-03-29 17:33:37'),
(30559, 1006, 23463, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:44:36', '2021-03-25 10:44:36'),
(30560, 1006, 23463, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:33:45', '2021-03-29 17:33:45'),
(30561, 1006, 23464, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:22', '2021-03-25 10:45:22'),
(30562, 1006, 23464, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:51', '2021-04-08 18:48:51'),
(30563, 9057, 23464, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:16:56', '2021-05-25 10:16:56'),
(30564, 1006, 23464, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:53', '2021-06-11 14:12:53'),
(30565, 1006, 23464, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:17', '2021-07-01 13:46:17'),
(30566, 1006, 23464, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:38', '2021-07-12 13:36:38'),
(30567, 1006, 23464, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:18', '2021-08-02 17:05:18'),
(30568, 1006, 23464, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:41:03', '2021-08-05 09:41:03'),
(30569, 11056, 23464, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:39:31', '2021-09-30 13:39:31'),
(30570, 1006, 23465, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:23', '2021-03-25 10:45:23'),
(30571, 1006, 23465, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:55', '2021-04-08 18:48:55'),
(30572, 9057, 23465, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:06', '2021-05-25 10:17:06'),
(30573, 1006, 23465, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:49', '2021-06-11 14:12:49'),
(30574, 1006, 23465, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:14', '2021-07-01 13:46:14'),
(30575, 1006, 23465, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:42', '2021-07-12 13:36:42'),
(30576, 1006, 23465, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:14', '2021-08-02 17:05:14'),
(30577, 1006, 23465, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:40:54', '2021-08-05 09:40:54'),
(30578, 11056, 23465, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:39:59', '2021-09-30 13:39:59'),
(30579, 1006, 23466, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:24', '2021-03-25 10:45:24'),
(30580, 1006, 23466, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:48:59', '2021-04-08 18:48:59'),
(30581, 9057, 23466, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:18', '2021-05-25 10:17:18'),
(30582, 1006, 23466, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:46', '2021-06-11 14:12:46'),
(30583, 1006, 23466, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:12', '2021-07-01 13:46:12'),
(30584, 1006, 23466, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:46', '2021-07-12 13:36:46'),
(30585, 1006, 23466, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:10', '2021-08-02 17:05:10'),
(30586, 1006, 23466, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:51', '2021-08-05 09:37:51'),
(30587, 11056, 23466, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:40:04', '2021-09-30 13:40:04'),
(30588, 1006, 23467, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:25', '2021-03-25 10:45:25'),
(30589, 1006, 23467, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:04', '2021-04-08 18:46:04'),
(30590, 9057, 23467, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:29', '2021-05-25 10:17:29'),
(30591, 1006, 23467, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:41', '2021-06-11 14:12:41'),
(30592, 1006, 23467, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:09', '2021-07-01 13:46:09'),
(30593, 1006, 23467, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:50', '2021-07-12 13:36:50'),
(30594, 1006, 23467, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:05', '2021-08-02 17:05:05'),
(30595, 1006, 23467, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:43', '2021-08-05 09:37:43'),
(30596, 11056, 23467, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:40:11', '2021-09-30 13:40:11'),
(30597, 1006, 23468, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:26', '2021-03-25 10:45:26'),
(30598, 1006, 23468, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:09', '2021-04-08 18:46:09'),
(30599, 9057, 23468, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:39', '2021-05-25 10:17:39'),
(30600, 1006, 23468, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:12', '2021-06-11 14:12:12'),
(30601, 1006, 23468, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:06', '2021-07-01 13:46:06'),
(30602, 1006, 23468, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:53', '2021-07-12 13:36:53'),
(30603, 1006, 23468, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:05:01', '2021-08-02 17:05:01'),
(30604, 1006, 23468, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:27', '2021-08-05 09:37:27'),
(30605, 11056, 23468, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:40:21', '2021-09-30 13:40:21'),
(30606, 1006, 23469, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:27', '2021-03-25 10:45:27'),
(30607, 1006, 23469, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:13', '2021-04-08 18:46:13'),
(30608, 9057, 23469, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:46', '2021-05-25 10:17:46'),
(30609, 1006, 23469, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:08', '2021-06-11 14:12:08'),
(30610, 1006, 23469, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:03', '2021-07-01 13:46:03'),
(30611, 1006, 23469, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:56', '2021-07-12 13:36:56'),
(30612, 1006, 23469, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:04:57', '2021-08-02 17:04:57');
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
(30613, 1006, 23469, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:23', '2021-08-05 09:37:23'),
(30614, 11056, 23469, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:40:29', '2021-09-30 13:40:29'),
(30615, 1006, 23470, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:28', '2021-03-25 10:45:28'),
(30616, 1006, 23470, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:22', '2021-04-08 18:46:22'),
(30617, 9057, 23470, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:17:53', '2021-05-25 10:17:53'),
(30618, 9057, 23470, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:02', '2021-05-25 10:18:02'),
(30619, 1006, 23470, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:05', '2021-06-11 14:12:05'),
(30620, 1006, 23470, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:46:00', '2021-07-01 13:46:00'),
(30621, 1006, 23470, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:36:59', '2021-07-12 13:36:59'),
(30622, 1006, 23470, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:04:55', '2021-08-02 17:04:55'),
(30623, 1006, 23470, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:19', '2021-08-05 09:37:19'),
(30624, 11056, 23470, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:40:35', '2021-09-30 13:40:35'),
(30625, 1006, 23471, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:30', '2021-03-25 10:45:30'),
(30626, 1006, 23471, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:28', '2021-04-08 18:46:28'),
(30627, 9057, 23471, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:15', '2021-05-25 10:18:15'),
(30628, 1006, 23471, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:12:02', '2021-06-11 14:12:02'),
(30629, 1006, 23471, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:45:57', '2021-07-01 13:45:57'),
(30630, 1006, 23471, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:37:02', '2021-07-12 13:37:02'),
(30631, 1006, 23471, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:04:51', '2021-08-02 17:04:51'),
(30632, 1006, 23471, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:15', '2021-08-05 09:37:15'),
(30633, 11056, 23471, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:41:03', '2021-09-30 13:41:03'),
(30634, 1006, 23472, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:31', '2021-03-25 10:45:31'),
(30635, 1006, 23472, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:34', '2021-04-08 18:46:34'),
(30636, 9057, 23472, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:24', '2021-05-25 10:18:24'),
(30637, 1006, 23472, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:11:36', '2021-06-11 14:11:36'),
(30638, 1006, 23472, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 13:45:51', '2021-07-01 13:45:51'),
(30639, 1006, 23472, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:37:05', '2021-07-12 13:37:05'),
(30640, 1006, 23472, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:04:48', '2021-08-02 17:04:48'),
(30641, 1006, 23472, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:37:10', '2021-08-05 09:37:10'),
(30642, 11056, 23472, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:41:10', '2021-09-30 13:41:10'),
(30643, 1006, 23473, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:45:32', '2021-03-25 10:45:32'),
(30644, 1006, 23473, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:37', '2021-04-08 18:46:37'),
(30645, 9057, 23473, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:18:32', '2021-05-25 10:18:32'),
(30646, 1006, 23473, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:10:25', '2021-06-11 14:10:25'),
(30647, 1006, 23473, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \"', NULL, NULL, '2021-07-01 13:45:14', '2021-07-01 13:45:14'),
(30648, 1006, 23473, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \"', NULL, NULL, '2021-07-12 13:37:08', '2021-07-12 13:37:08'),
(30649, 1006, 23473, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:04:41', '2021-08-02 17:04:41'),
(30650, 1006, 23473, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:36:58', '2021-08-05 09:36:58'),
(30651, 11056, 23473, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:41:15', '2021-09-30 13:41:15'),
(30652, 1006, 23474, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:33', '2021-03-25 10:46:33'),
(30653, 1006, 23474, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:58', '2021-03-26 14:34:58'),
(30654, 1006, 23475, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:34', '2021-03-25 10:46:34'),
(30655, 1006, 23475, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:52', '2021-03-26 14:34:52'),
(30656, 1006, 23476, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:35', '2021-03-25 10:46:35'),
(30657, 1006, 23476, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:46', '2021-03-26 14:34:46'),
(30658, 1006, 23477, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:36', '2021-03-25 10:46:36'),
(30659, 1006, 23477, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:35', '2021-03-26 14:34:35'),
(30660, 1006, 23478, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:37', '2021-03-25 10:46:37'),
(30661, 1006, 23478, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:12', '2021-03-26 14:34:12'),
(30662, 1006, 23479, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:38', '2021-03-25 10:46:38'),
(30663, 1006, 23479, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:00', '2021-03-26 14:34:00'),
(30664, 1006, 23480, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:39', '2021-03-25 10:46:39'),
(30665, 1006, 23480, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:33:54', '2021-03-26 14:33:54'),
(30666, 1006, 23481, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:40', '2021-03-25 10:46:40'),
(30667, 1006, 23481, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:33:48', '2021-03-26 14:33:48'),
(30668, 1006, 23482, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:41', '2021-03-25 10:46:41'),
(30669, 1006, 23482, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:33:42', '2021-03-26 14:33:42'),
(30670, 1006, 23483, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:42', '2021-03-25 10:46:42'),
(30671, 1006, 23483, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:33:36', '2021-03-26 14:33:36'),
(30672, 1006, 23484, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 10:46:43', '2021-03-25 10:46:43'),
(30673, 1006, 23484, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:34:05', '2021-03-26 14:34:05'),
(30674, 1006, 23505, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:22', '2021-03-25 11:13:22'),
(30675, 1006, 23505, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:07', '2021-03-25 16:55:07'),
(30676, 1006, 23506, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:23', '2021-03-25 11:13:23'),
(30677, 1006, 23506, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:16', '2021-03-25 16:55:16'),
(30678, 1006, 23507, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:24', '2021-03-25 11:13:24'),
(30679, 1006, 23507, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:25', '2021-03-25 16:55:25'),
(30680, 1006, 23508, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:25', '2021-03-25 11:13:25'),
(30681, 1006, 23508, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:32', '2021-03-25 16:55:32'),
(30682, 1006, 23509, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:26', '2021-03-25 11:13:26'),
(30683, 1006, 23509, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:36', '2021-03-25 16:55:36'),
(30684, 1006, 23510, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:27', '2021-03-25 11:13:27'),
(30685, 1006, 23510, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:40', '2021-03-25 16:55:40'),
(30686, 1006, 23511, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:28', '2021-03-25 11:13:28'),
(30687, 1006, 23511, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:45', '2021-03-25 16:55:45'),
(30688, 1006, 23512, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:28', '2021-03-25 11:13:28'),
(30689, 1006, 23512, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:49', '2021-03-25 16:55:49'),
(30690, 1006, 23513, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:29', '2021-03-25 11:13:29'),
(30691, 1006, 23513, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:55:54', '2021-03-25 16:55:54'),
(30692, 1006, 23514, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:30', '2021-03-25 11:13:30'),
(30693, 1006, 23514, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:56:00', '2021-03-25 16:56:00'),
(30694, 1006, 23515, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:13:31', '2021-03-25 11:13:31'),
(30695, 1006, 23515, NULL, '2021-04-01 00:00:00.000', 'Approved', 'We have an urgent care/facility contract with First Health. We don\'t need to individually enroll/credential providers separately, a copy of the executed contract has been attached and the directory confirmations are also attached for reference.  ', NULL, NULL, '2021-03-25 16:56:04', '2021-03-25 16:56:04'),
(30696, 1006, 23536, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:51', '2021-03-25 11:15:51'),
(30697, 3040, 23536, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:38:32', '2021-03-30 12:38:32'),
(30698, 9057, 23536, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:11', '2021-05-26 13:37:11'),
(30699, 1006, 23536, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:15', '2021-06-11 14:32:15'),
(30700, 1006, 23536, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:03:00', '2021-06-25 11:03:00'),
(30701, 1006, 23537, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:52', '2021-03-25 11:15:52');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30702, 3040, 23537, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:38:11', '2021-03-30 12:38:11'),
(30703, 9057, 23537, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:19', '2021-05-26 13:37:19'),
(30704, 1006, 23537, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:11', '2021-06-11 14:32:11'),
(30705, 1006, 23537, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:56', '2021-06-25 11:02:56'),
(30706, 1006, 23538, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:53', '2021-03-25 11:15:53'),
(30707, 3040, 23538, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:39:22', '2021-03-30 12:39:22'),
(30708, 9057, 23538, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:27', '2021-05-26 13:37:27'),
(30709, 1006, 23538, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:08', '2021-06-11 14:32:08'),
(30710, 1006, 23538, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:53', '2021-06-25 11:02:53'),
(30711, 1006, 23539, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:54', '2021-03-25 11:15:54'),
(30712, 3040, 23539, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:39:51', '2021-03-30 12:39:51'),
(30713, 9057, 23539, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:33', '2021-05-26 13:37:33'),
(30714, 1006, 23539, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:32:02', '2021-06-11 14:32:02'),
(30715, 1006, 23539, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:50', '2021-06-25 11:02:50'),
(30716, 1006, 23540, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:55', '2021-03-25 11:15:55'),
(30717, 3040, 23540, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:40:20', '2021-03-30 12:40:20'),
(30718, 9057, 23540, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:41', '2021-05-26 13:37:41'),
(30719, 1006, 23540, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:59', '2021-06-11 14:31:59'),
(30720, 1006, 23540, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:47', '2021-06-25 11:02:47'),
(30721, 1006, 23541, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:56', '2021-03-25 11:15:56'),
(30722, 3040, 23541, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:40:54', '2021-03-30 12:40:54'),
(30723, 9057, 23541, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:49', '2021-05-26 13:37:49'),
(30724, 1006, 23541, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:49', '2021-06-11 14:31:49'),
(30725, 1006, 23541, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:44', '2021-06-25 11:02:44'),
(30726, 1006, 23542, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:57', '2021-03-25 11:15:57'),
(30727, 3040, 23542, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:37:38', '2021-03-30 12:37:38'),
(30728, 9057, 23542, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:55', '2021-05-26 13:37:55'),
(30729, 1006, 23542, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:45', '2021-06-11 14:31:45'),
(30730, 1006, 23542, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:41', '2021-06-25 11:02:41'),
(30731, 1006, 23543, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:58', '2021-03-25 11:15:58'),
(30732, 3040, 23543, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:41:20', '2021-03-30 12:41:20');
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
(30733, 9057, 23543, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:38:03', '2021-05-26 13:38:03'),
(30734, 1006, 23543, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:42', '2021-06-11 14:31:42'),
(30735, 1006, 23543, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:38', '2021-06-25 11:02:38'),
(30736, 1006, 23544, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:15:59', '2021-03-25 11:15:59'),
(30737, 3040, 23544, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:41:47', '2021-03-30 12:41:47'),
(30738, 9057, 23544, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:38:09', '2021-05-26 13:38:09'),
(30739, 1006, 23544, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:37', '2021-06-11 14:31:37'),
(30740, 1006, 23544, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:35', '2021-06-25 11:02:35'),
(30741, 1006, 23545, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:16:00', '2021-03-25 11:16:00'),
(30742, 3040, 23545, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:42:18', '2021-03-30 12:42:18'),
(30743, 9057, 23545, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:38:16', '2021-05-26 13:38:16'),
(30744, 1006, 23545, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:31:08', '2021-06-11 14:31:08'),
(30745, 1006, 23545, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:02:23', '2021-06-25 11:02:23'),
(30746, 1006, 23546, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:16:01', '2021-03-25 11:16:01'),
(30747, 3040, 23546, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group participating with insurance.   Please see attachment. ', NULL, NULL, '2021-03-30 10:30:28', '2021-03-30 10:30:28'),
(30748, 1006, 23557, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:02', '2021-03-25 11:19:02'),
(30749, 1006, 23557, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:51:10', '2021-03-26 16:51:10'),
(30750, 1006, 23558, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:03', '2021-03-25 11:19:03'),
(30751, 1006, 23558, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:55:30', '2021-03-26 16:55:30'),
(30752, 1006, 23559, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:04', '2021-03-25 11:19:04'),
(30753, 1006, 23559, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:56:07', '2021-03-26 16:56:07'),
(30754, 1006, 23560, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:05', '2021-03-25 11:19:05'),
(30755, 1006, 23560, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:56:38', '2021-03-26 16:56:38'),
(30756, 1006, 23561, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:06', '2021-03-25 11:19:06'),
(30757, 1006, 23561, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:57:07', '2021-03-26 16:57:07'),
(30758, 1006, 23562, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:07', '2021-03-25 11:19:07'),
(30759, 1006, 23562, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:57:29', '2021-03-26 16:57:29'),
(30760, 1006, 23563, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:08', '2021-03-25 11:19:08'),
(30761, 1006, 23563, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:57:54', '2021-03-26 16:57:54'),
(30762, 1006, 23564, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:09', '2021-03-25 11:19:09'),
(30763, 1006, 23564, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:58:46', '2021-03-26 16:58:46'),
(30764, 1006, 23565, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:10', '2021-03-25 11:19:10'),
(30765, 1006, 23565, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:59:24', '2021-03-26 16:59:24'),
(30766, 1006, 23566, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:11', '2021-03-25 11:19:11'),
(30767, 1006, 23566, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 16:59:55', '2021-03-26 16:59:55'),
(30768, 1006, 23567, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:19:12', '2021-03-25 11:19:12'),
(30769, 1006, 23567, NULL, '2021-04-02 00:00:00.000', 'Approved', 'The group is enrolled under an ancillary/facility contract, no need to enroll individual providers. Executed contract and location confirmation are attached for reference.  ', NULL, NULL, '2021-03-26 17:00:19', '2021-03-26 17:00:19'),
(30770, 1006, 23579, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:00', '2021-03-25 11:22:00'),
(30771, 3040, 23579, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:03:18', '2021-03-30 17:03:18'),
(30772, 1006, 23580, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:01', '2021-03-25 11:22:01'),
(30773, 3040, 23580, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:02:22', '2021-03-30 17:02:22'),
(30774, 3040, 23580, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:02:37', '2021-03-30 17:02:37'),
(30775, 1006, 23581, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:02', '2021-03-25 11:22:02'),
(30776, 3040, 23581, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:01:34', '2021-03-30 17:01:34'),
(30777, 1006, 23582, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:03', '2021-03-25 11:22:03'),
(30778, 3040, 23582, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:00:59', '2021-03-30 17:00:59'),
(30779, 1006, 23583, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:04', '2021-03-25 11:22:04'),
(30780, 3040, 23583, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:00:25', '2021-03-30 17:00:25'),
(30781, 1006, 23584, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:05', '2021-03-25 11:22:05'),
(30782, 3040, 23584, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:59:37', '2021-03-30 16:59:37'),
(30783, 1006, 23585, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:06', '2021-03-25 11:22:06'),
(30784, 3040, 23585, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:58:55', '2021-03-30 16:58:55'),
(30785, 1006, 23586, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:07', '2021-03-25 11:22:07'),
(30786, 3040, 23586, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:58:15', '2021-03-30 16:58:15'),
(30787, 1006, 23587, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:08', '2021-03-25 11:22:08'),
(30788, 3040, 23587, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:56:57', '2021-03-30 16:56:57'),
(30789, 1006, 23588, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:09', '2021-03-25 11:22:09'),
(30790, 3040, 23588, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:56:12', '2021-03-30 16:56:12'),
(30791, 1006, 23589, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:10', '2021-03-25 11:22:10'),
(30792, 3040, 23589, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:55:17', '2021-03-30 16:55:17'),
(30793, 1006, 23590, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:40', '2021-03-25 11:22:40'),
(30794, 1006, 23590, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:10', '2021-03-26 13:23:10'),
(30795, 1006, 23591, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:41', '2021-03-25 11:22:41'),
(30796, 1006, 23591, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:20', '2021-03-26 13:23:20'),
(30797, 1006, 23592, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:42', '2021-03-25 11:22:42'),
(30798, 1006, 23592, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:29', '2021-03-26 13:23:29'),
(30799, 1006, 23593, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:43', '2021-03-25 11:22:43'),
(30800, 1006, 23593, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:34', '2021-03-26 13:23:34'),
(30801, 1006, 23594, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:44', '2021-03-25 11:22:44'),
(30802, 1006, 23594, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:39', '2021-03-26 13:23:39'),
(30803, 1006, 23595, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:45', '2021-03-25 11:22:45'),
(30804, 1006, 23595, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:23:43', '2021-03-26 13:23:43'),
(30805, 1006, 23596, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:46', '2021-03-25 11:22:46'),
(30806, 1006, 23596, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:24:03', '2021-03-26 13:24:03'),
(30807, 1006, 23597, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:46', '2021-03-25 11:22:46'),
(30808, 1006, 23597, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:24:07', '2021-03-26 13:24:07'),
(30809, 1006, 23598, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:47', '2021-03-25 11:22:47'),
(30810, 1006, 23598, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:24:12', '2021-03-26 13:24:12'),
(30811, 1006, 23599, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:48', '2021-03-25 11:22:48'),
(30812, 1006, 23599, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:24:18', '2021-03-26 13:24:18'),
(30813, 1006, 23600, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:22:49', '2021-03-25 11:22:49'),
(30814, 1006, 23600, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:24:35', '2021-03-26 13:24:35'),
(30815, 1006, 23612, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:04', '2021-03-25 11:25:04'),
(30816, 3040, 23612, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:47:46', '2021-03-31 15:47:46'),
(30817, 1006, 23613, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:05', '2021-03-25 11:25:05'),
(30818, 3040, 23613, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:01', '2021-03-31 15:48:01'),
(30819, 1006, 23614, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:06', '2021-03-25 11:25:06'),
(30820, 3040, 23614, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:16', '2021-03-31 15:48:16'),
(30821, 1006, 23615, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:07', '2021-03-25 11:25:07'),
(30822, 3040, 23615, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:34', '2021-03-31 15:48:34'),
(30823, 1006, 23616, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:08', '2021-03-25 11:25:08'),
(30824, 3040, 23616, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:48:53', '2021-03-31 15:48:53'),
(30825, 1006, 23617, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:09', '2021-03-25 11:25:09'),
(30826, 3040, 23617, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:07', '2021-03-31 15:49:07'),
(30827, 1006, 23618, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:09', '2021-03-25 11:25:09'),
(30828, 3040, 23618, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:21', '2021-03-31 15:49:21'),
(30829, 1006, 23619, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:10', '2021-03-25 11:25:10'),
(30830, 3040, 23619, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:35', '2021-03-31 15:49:35'),
(30831, 1006, 23620, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:11', '2021-03-25 11:25:11'),
(30832, 3040, 23620, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:49:50', '2021-03-31 15:49:50'),
(30833, 1006, 23621, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:25:12', '2021-03-25 11:25:12'),
(30834, 3040, 23621, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'They do not cover the county. ', NULL, NULL, '2021-03-31 15:50:05', '2021-03-31 15:50:05'),
(30835, 1006, 23622, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:11', '2021-03-25 11:26:11'),
(30836, 1006, 23622, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:22', '2021-03-29 17:37:22'),
(30837, 1006, 23623, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:12', '2021-03-25 11:26:12'),
(30838, 1006, 23623, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:27', '2021-03-29 17:37:27'),
(30839, 1006, 23624, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:12', '2021-03-25 11:26:12'),
(30840, 1006, 23624, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:32', '2021-03-29 17:37:32'),
(30841, 1006, 23625, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:13', '2021-03-25 11:26:13'),
(30842, 1006, 23625, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:37', '2021-03-29 17:37:37'),
(30843, 1006, 23626, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:14', '2021-03-25 11:26:14'),
(30844, 1006, 23626, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:42', '2021-03-29 17:37:42'),
(30845, 1006, 23627, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:15', '2021-03-25 11:26:15'),
(30846, 1006, 23627, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:47', '2021-03-29 17:37:47'),
(30847, 1006, 23628, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:16', '2021-03-25 11:26:16'),
(30848, 1006, 23628, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:37:55', '2021-03-29 17:37:55'),
(30849, 1006, 23629, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:17', '2021-03-25 11:26:17'),
(30850, 1006, 23629, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:38:01', '2021-03-29 17:38:01'),
(30851, 1006, 23630, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:17', '2021-03-25 11:26:17'),
(30852, 1006, 23630, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:38:13', '2021-03-29 17:38:13'),
(30853, 1006, 23631, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:18', '2021-03-25 11:26:18'),
(30854, 1006, 23631, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:38:30', '2021-03-29 17:38:30'),
(30855, 1006, 23632, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:26:19', '2021-03-25 11:26:19'),
(30856, 1006, 23632, NULL, '2021-04-05 00:00:00.000', 'Rejected', 'We do not fall under Amerigroup enrollment services area as they do not cover Kleberg County or Nueces County, map is here @ https://www.myamerigroup.com/tx/apply/know-your-service-area.html', NULL, NULL, '2021-03-29 17:38:45', '2021-03-29 17:38:45'),
(30857, 1006, 23633, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:13', '2021-03-25 11:27:13'),
(30858, 1006, 23633, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:04:04', '2021-04-06 14:04:04'),
(30859, 1006, 23634, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:15', '2021-03-25 11:27:15'),
(30860, 1006, 23634, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:04:30', '2021-04-06 14:04:30'),
(30861, 1006, 23635, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:16', '2021-03-25 11:27:16'),
(30862, 1006, 23635, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:06:24', '2021-04-06 14:06:24'),
(30863, 1006, 23636, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:17', '2021-03-25 11:27:17'),
(30864, 1006, 23636, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:06:35', '2021-04-06 14:06:35'),
(30865, 1006, 23637, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:18', '2021-03-25 11:27:18'),
(30866, 1006, 23637, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:01', '2021-04-06 14:07:01'),
(30867, 1006, 23638, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:19', '2021-03-25 11:27:19'),
(30868, 1006, 23638, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:09', '2021-04-06 14:07:09'),
(30869, 1006, 23639, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:20', '2021-03-25 11:27:20'),
(30870, 1006, 23639, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:20', '2021-04-06 14:07:20'),
(30871, 1006, 23640, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:21', '2021-03-25 11:27:21'),
(30872, 1006, 23640, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:32', '2021-04-06 14:07:32'),
(30873, 1006, 23641, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:22', '2021-03-25 11:27:22'),
(30874, 1006, 23641, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:45', '2021-04-06 14:07:45'),
(30875, 1006, 23642, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:23', '2021-03-25 11:27:23'),
(30876, 1006, 23642, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:07:53', '2021-04-06 14:07:53'),
(30877, 1006, 23643, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:24', '2021-03-25 11:27:24'),
(30878, 1006, 23643, NULL, '2021-04-13 00:00:00.000', 'Approved', 'Requested approval confirmation from Michal Simms, received an email from Simms, Michal michal.simms@christushealth.org:  Sub: Email Subject: RE: Claim Denial Query - Statcare Minor Emergency Clinic - CHP	  \"Brad,  These are the locations that are currently credentialed with us and are effective 2/1/2019:  A copy of the original application is attached.  Let me know if you have other questions.  Thanks, Michal\"  Location confirmation that was received from her is attached on the group task as it is an ancillary facility contract.  ', NULL, NULL, '2021-04-06 14:08:05', '2021-04-06 14:08:05'),
(30879, 1006, 23644, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:27:59', '2021-03-25 11:27:59');
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
(30880, 1006, 23644, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:41', '2021-04-08 18:46:41'),
(30881, 9057, 23644, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:13:25', '2021-05-25 10:13:25'),
(30882, 1006, 23644, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:43', '2021-06-11 14:14:43'),
(30883, 3040, 23644, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:09', '2021-06-30 15:21:09'),
(30884, 1006, 23644, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:10:28', '2021-07-01 14:10:28'),
(30885, 1006, 23644, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:53', '2021-07-12 13:40:53'),
(30886, 1006, 23644, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:28', '2021-08-02 17:08:28'),
(30887, 1006, 23644, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:50:23', '2021-08-05 09:50:23'),
(30888, 11056, 23644, NULL, '2021-10-07 00:00:00.000', 'Approved', 'Email received from : michal.simms@christushealth.org  Sub : Fwd: Additional location status request - Reference# FL01346390- RHC - CHRISTUS HEALTH PLAN  Hello,  The additional service locations were loaded in our system on 8/23/21.  Facility contracting is completed.  Eff date is : 09/1/2021   Confirmed with rep.  Rep. : Jackie P  Ref code : JackieP  Please see the attachment.', NULL, NULL, '2021-09-30 13:30:43', '2021-09-30 13:30:43'),
(30889, 1006, 23645, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:00', '2021-03-25 11:28:00'),
(30890, 1006, 23645, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:45', '2021-04-08 18:46:45'),
(30891, 9057, 23645, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:13:40', '2021-05-25 10:13:40'),
(30892, 1006, 23645, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:40', '2021-06-11 14:14:40'),
(30893, 3040, 23645, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:08', '2021-06-30 15:21:08'),
(30894, 1006, 23645, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:10:25', '2021-07-01 14:10:25'),
(30895, 1006, 23645, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:49', '2021-07-12 13:40:49'),
(30896, 1006, 23645, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:25', '2021-08-02 17:08:25'),
(30897, 1006, 23645, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:50:17', '2021-08-05 09:50:17'),
(30898, 11056, 23645, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:41:51', '2021-09-30 13:41:51'),
(30899, 1006, 23646, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:01', '2021-03-25 11:28:01'),
(30900, 1006, 23646, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:49', '2021-04-08 18:46:49'),
(30901, 9057, 23646, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:13:56', '2021-05-25 10:13:56'),
(30902, 1006, 23646, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:37', '2021-06-11 14:14:37'),
(30903, 3040, 23646, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:08', '2021-06-30 15:21:08'),
(30904, 1006, 23646, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:10:22', '2021-07-01 14:10:22'),
(30905, 1006, 23646, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:45', '2021-07-12 13:40:45'),
(30906, 1006, 23646, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:21', '2021-08-02 17:08:21'),
(30907, 1006, 23646, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:50:12', '2021-08-05 09:50:12'),
(30908, 11056, 23646, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:41:57', '2021-09-30 13:41:57'),
(30909, 1006, 23647, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:02', '2021-03-25 11:28:02'),
(30910, 1006, 23647, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:53', '2021-04-08 18:46:53'),
(30911, 9057, 23647, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:14:10', '2021-05-25 10:14:10'),
(30912, 1006, 23647, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:34', '2021-06-11 14:14:34'),
(30913, 3040, 23647, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:07', '2021-06-30 15:21:07'),
(30914, 1006, 23647, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:10:17', '2021-07-01 14:10:17'),
(30915, 1006, 23647, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:42', '2021-07-12 13:40:42'),
(30916, 1006, 23647, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:18', '2021-08-02 17:08:18'),
(30917, 1006, 23647, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:50:08', '2021-08-05 09:50:08'),
(30918, 11056, 23647, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:05', '2021-09-30 13:42:05'),
(30919, 1006, 23648, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:03', '2021-03-25 11:28:03'),
(30920, 1006, 23648, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:46:57', '2021-04-08 18:46:57'),
(30921, 9057, 23648, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:14:20', '2021-05-25 10:14:20'),
(30922, 1006, 23648, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:30', '2021-06-11 14:14:30'),
(30923, 3040, 23648, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:06', '2021-06-30 15:21:06'),
(30924, 1006, 23648, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:59', '2021-07-01 14:09:59'),
(30925, 1006, 23648, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:39', '2021-07-12 13:40:39'),
(30926, 1006, 23648, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:14', '2021-08-02 17:08:14'),
(30927, 1006, 23648, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:50:03', '2021-08-05 09:50:03'),
(30928, 11056, 23648, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:11', '2021-09-30 13:42:11'),
(30929, 1006, 23649, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:04', '2021-03-25 11:28:04'),
(30930, 1006, 23649, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:00', '2021-04-08 18:47:00'),
(30931, 9057, 23649, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:14:36', '2021-05-25 10:14:36'),
(30932, 1006, 23649, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:27', '2021-06-11 14:14:27'),
(30933, 3040, 23649, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:05', '2021-06-30 15:21:05'),
(30934, 1006, 23649, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:54', '2021-07-01 14:09:54'),
(30935, 1006, 23649, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:36', '2021-07-12 13:40:36'),
(30936, 1006, 23649, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:11', '2021-08-02 17:08:11'),
(30937, 1006, 23649, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:58', '2021-08-05 09:49:58'),
(30938, 11056, 23649, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:18', '2021-09-30 13:42:18'),
(30939, 1006, 23650, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:05', '2021-03-25 11:28:05');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(30940, 1006, 23650, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:04', '2021-04-08 18:47:04'),
(30941, 9057, 23650, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:14:44', '2021-05-25 10:14:44'),
(30942, 1006, 23650, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:24', '2021-06-11 14:14:24'),
(30943, 3040, 23650, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:05', '2021-06-30 15:21:05'),
(30944, 1006, 23650, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:46', '2021-07-01 14:09:46'),
(30945, 1006, 23650, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:34', '2021-07-12 13:40:34'),
(30946, 1006, 23650, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:08', '2021-08-02 17:08:08'),
(30947, 1006, 23650, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:53', '2021-08-05 09:49:53'),
(30948, 11056, 23650, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:25', '2021-09-30 13:42:25'),
(30949, 1006, 23651, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:06', '2021-03-25 11:28:06'),
(30950, 1006, 23651, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:08', '2021-04-08 18:47:08'),
(30951, 9057, 23651, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:14:55', '2021-05-25 10:14:55'),
(30952, 1006, 23651, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:21', '2021-06-11 14:14:21'),
(30953, 3040, 23651, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:04', '2021-06-30 15:21:04'),
(30954, 1006, 23651, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:42', '2021-07-01 14:09:42'),
(30955, 1006, 23651, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:29', '2021-07-12 13:40:29'),
(30956, 1006, 23651, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:04', '2021-08-02 17:08:04'),
(30957, 1006, 23651, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:48', '2021-08-05 09:49:48'),
(30958, 11056, 23651, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:32', '2021-09-30 13:42:32'),
(30959, 1006, 23652, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:07', '2021-03-25 11:28:07'),
(30960, 1006, 23652, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:11', '2021-04-08 18:47:11'),
(30961, 9057, 23652, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:15:10', '2021-05-25 10:15:10'),
(30962, 1006, 23652, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:19', '2021-06-11 14:14:19'),
(30963, 3040, 23652, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:03', '2021-06-30 15:21:03'),
(30964, 1006, 23652, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:37', '2021-07-01 14:09:37'),
(30965, 1006, 23652, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:26', '2021-07-12 13:40:26'),
(30966, 1006, 23652, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:08:01', '2021-08-02 17:08:01'),
(30967, 1006, 23652, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:43', '2021-08-05 09:49:43'),
(30968, 11056, 23652, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:38', '2021-09-30 13:42:38'),
(30969, 1006, 23653, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:08', '2021-03-25 11:28:08'),
(30970, 1006, 23653, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:15', '2021-04-08 18:47:15'),
(30971, 9057, 23653, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:15:26', '2021-05-25 10:15:26'),
(30972, 9057, 23653, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:15:45', '2021-05-25 10:15:45'),
(30973, 1006, 23653, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:15', '2021-06-11 14:14:15'),
(30974, 3040, 23653, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:03', '2021-06-30 15:21:03'),
(30975, 1006, 23653, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:30', '2021-07-01 14:09:30'),
(30976, 1006, 23653, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:23', '2021-07-12 13:40:23'),
(30977, 1006, 23653, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:57', '2021-08-02 17:07:57'),
(30978, 1006, 23653, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:38', '2021-08-05 09:49:38'),
(30979, 11056, 23653, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:45', '2021-09-30 13:42:45'),
(30980, 1006, 23654, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:09', '2021-03-25 11:28:09'),
(30981, 1006, 23654, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Sent following enrollment request email @ CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,   I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?   Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.   Thank you. \" ', NULL, NULL, '2021-04-08 18:47:18', '2021-04-08 18:47:18'),
(30982, 9057, 23654, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent following email to CSHNproviderrelations@christushealth.org:  Sub: Provider/Group Enrollment Status - RHC - Christus Spohn  \"Hello, We want to know the current status of the request we sent to you last month about the enrollment for the following group and its providers:  Group Name: Statcare Minor Emergency Clinic NPI#  1689924904  TIN#  46-0575924  Please get back to us as soon as possible.  Thank you\"', NULL, NULL, '2021-05-25 10:16:31', '2021-05-25 10:16:31'),
(30983, 1006, 23654, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a VM to Vicki Gera @ (800) 419-3461 as we haven\'t been receiving any replies on emails. ', NULL, NULL, '2021-06-11 14:14:12', '2021-06-11 14:14:12'),
(30984, 3040, 23654, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject:  Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hello,  I hope you\'re doing well, we wanted to enroll our group and the following providers with Christus Spohn, please let me know what is required to proceed with this request?  Provider Information is as follows:  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-30 15:21:02', '2021-06-30 15:21:02'),
(30985, 1006, 23654, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from vicki.guerra@christushealth.org:  Sub: Provider/Group Enrollment Request - RHC - Christus Spohn  \"Hi Adil,  Happy Wednesday!  Thank you for reaching out. We would like for Statcare Minor Emergency Clinic to come back on board. The last time we spoke it was to my understanding that Ms. Rabagos did not have a sponsoring physician with hospital privileges for a Christus facility. This is one of the requirements to bring this provider group back on board with a new contract.  Is there a sponsor/supervising physician who has hospital affiliations at a Christus Facility that Ms. Rabagos will be utilizing?  Vicki Ann Guerra  Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  Sent following reply:  \"Hello Vicki,   I appreciate the update, would you be able to check again if David Gray (NPI# 1902814874) now has hospital privileges with a Christus facility?   Thank you. \" ', NULL, NULL, '2021-07-01 14:09:24', '2021-07-01 14:09:24'),
(30986, 1006, 23654, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Sent following email to Vicki @ Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Hospital Privileges - Gray  \"Hello Vicki,   I apologize for the incorrect information, the correct supervising physician for Katherine is Luis Leyton Gonzalez (NPI# 1013911601), please look into this provider instead.   Thank you. \" ', NULL, NULL, '2021-07-12 13:40:10', '2021-07-12 13:40:10'),
(30987, 1006, 23654, NULL, '2021-08-09 00:00:00.000', 'In Process', 'We received the following reply from vicki.guerra@christushealth.org:  Sub: vicki.guerra@christushealth.org  \"Hi Brad,  Happy Tuesday!  Can I have the last 4 of Dr. Leyton Gonzalez SS? This is the only way for me to verify in the portal along with NPI.  Thanks,  Vicki Ann Guerra Provider Relations Representative CHRISTUS Spohn Health Network 613 Elizabeth St Ste 604 Corpus Christi, TX 78404 O: 361-881-3167 F: 361-881-3745\"  I replied with the requested information to her.', NULL, NULL, '2021-08-02 17:07:54', '2021-08-02 17:07:54'),
(30988, 1006, 23654, NULL, '2021-08-12 00:00:00.000', 'Not Eligible', 'Received the following denial notification:  Sub: Denial Letter CSHN: STATCARE Contract  \"August 3, 2021  STATCARE Administrator/Owner Rabagos C/O – Office Manager  Dear Administrator and Owner Rabagos (OM), Thank you for your continuous efforts to participate in the Christus Spohn Health Network. Currently to contract with CSHN, Ms. Rabagos will need to have a sponsoring physician to participate in the network. The requirement for a sponsoring physician is to have and maintain  hospital affiliations/memberships with a Christus facility as per Article 5.5 in CSHNs contract agreement and Section I, Article III, Section(s) 3.2-1 and 3.6. CSHN would love to see STACARE back on the Spohn Network directory. Until this criterion for a sponsoring physician is met with hospital affiliations/memberships with a Christus facility CSHN cannot extend a contract.  Locations: STATCARE Kingsville 500 E Caesar Ave, Kingsville Texas 78363 STATCARE Calallen 4042 River Hill Drive Corpus Christi Texas 78410 STATCARE Corpus Christi Southside 6646 S Staples St #122 Corpus Christi Texas 78413 STATCARE Corpus Christi SPID 3817 S. Padre Island Dr. Corpus Christi Texas 78415 STATCARE Rockport 2102 FM 2165 Rockport Texas 78382  Have a blessed and wonderful day. Sincerely,  Vicki Ann Guerra Provider Relations Representative\"', NULL, NULL, '2021-08-05 09:49:32', '2021-08-05 09:49:32'),
(30989, 11056, 23654, NULL, '2021-10-07 00:00:00.000', 'Approved', 'There is no need to enrolled the provider in Ancillary contract.', NULL, NULL, '2021-09-30 13:42:51', '2021-09-30 13:42:51'),
(30990, 1006, 23655, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:44', '2021-03-25 11:28:44'),
(30991, 1006, 23655, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:39:16', '2021-03-26 14:39:16'),
(30992, 1006, 23656, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:45', '2021-03-25 11:28:45'),
(30993, 1006, 23656, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:39:11', '2021-03-26 14:39:11'),
(30994, 1006, 23657, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:46', '2021-03-25 11:28:46'),
(30995, 1006, 23657, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:39:05', '2021-03-26 14:39:05'),
(30996, 1006, 23658, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:47', '2021-03-25 11:28:47'),
(30997, 1006, 23658, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:59', '2021-03-26 14:38:59'),
(30998, 1006, 23659, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:48', '2021-03-25 11:28:48'),
(30999, 1006, 23659, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:54', '2021-03-26 14:38:54'),
(31000, 1006, 23660, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:49', '2021-03-25 11:28:49'),
(31001, 1006, 23660, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:43', '2021-03-26 14:38:43'),
(31002, 1006, 23661, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:50', '2021-03-25 11:28:50'),
(31003, 1006, 23661, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:37', '2021-03-26 14:38:37'),
(31004, 1006, 23662, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:50', '2021-03-25 11:28:50'),
(31005, 1006, 23662, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:30', '2021-03-26 14:38:30'),
(31006, 1006, 23663, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:51', '2021-03-25 11:28:51'),
(31007, 1006, 23663, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:25', '2021-03-26 14:38:25'),
(31008, 1006, 23664, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:52', '2021-03-25 11:28:52'),
(31009, 1006, 23664, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:18', '2021-03-26 14:38:18'),
(31010, 1006, 23665, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:28:53', '2021-03-25 11:28:53'),
(31011, 1006, 23665, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'CHC enrollment is not possible as our clinics do not fall under the CHC operating area, the map can be found @ https://www.communityhealthchoice.org/medicare/medicare-hmo-d-snp/service-area/  It is also attached for reference.  ', NULL, NULL, '2021-03-26 14:38:49', '2021-03-26 14:38:49'),
(31012, 1006, 23710, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:32:59', '2021-03-25 11:32:59'),
(31013, 3040, 23710, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group participating with insurance.   Please see attachment. ', NULL, NULL, '2021-03-30 10:30:35', '2021-03-30 10:30:35'),
(31014, 1006, 23711, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:00', '2021-03-25 11:33:00');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(31015, 3040, 23711, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:42:22', '2021-03-30 12:42:22'),
(31016, 9057, 23711, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:00', '2021-05-26 13:36:00'),
(31017, 1006, 23711, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:41', '2021-06-11 14:33:41'),
(31018, 1006, 23711, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:48', '2021-06-25 11:04:48'),
(31019, 1006, 23712, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:01', '2021-03-25 11:33:01'),
(31020, 3040, 23712, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:41:51', '2021-03-30 12:41:51'),
(31021, 9057, 23712, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:08', '2021-05-26 13:36:08'),
(31022, 1006, 23712, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:38', '2021-06-11 14:33:38'),
(31023, 1006, 23712, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:45', '2021-06-25 11:04:45'),
(31024, 1006, 23713, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:03', '2021-03-25 11:33:03'),
(31025, 3040, 23713, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:41:24', '2021-03-30 12:41:24'),
(31026, 9057, 23713, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:14', '2021-05-26 13:36:14'),
(31027, 1006, 23713, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:34', '2021-06-11 14:33:34'),
(31028, 1006, 23713, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:42', '2021-06-25 11:04:42'),
(31029, 1006, 23714, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:04', '2021-03-25 11:33:04'),
(31030, 3040, 23714, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:37:43', '2021-03-30 12:37:43'),
(31031, 9057, 23714, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:20', '2021-05-26 13:36:20'),
(31032, 1006, 23714, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:31', '2021-06-11 14:33:31'),
(31033, 1006, 23714, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:40', '2021-06-25 11:04:40'),
(31034, 1006, 23715, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:05', '2021-03-25 11:33:05'),
(31035, 3040, 23715, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:40:58', '2021-03-30 12:40:58'),
(31036, 9057, 23715, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:27', '2021-05-26 13:36:27'),
(31037, 1006, 23715, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:27', '2021-06-11 14:33:27'),
(31038, 1006, 23715, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:36', '2021-06-25 11:04:36'),
(31039, 1006, 23716, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:05', '2021-03-25 11:33:05'),
(31040, 3040, 23716, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:40:24', '2021-03-30 12:40:24'),
(31041, 9057, 23716, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:33', '2021-05-26 13:36:33'),
(31042, 1006, 23716, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:23', '2021-06-11 14:33:23'),
(31043, 1006, 23716, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:32', '2021-06-25 11:04:32'),
(31044, 1006, 23717, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:07', '2021-03-25 11:33:07'),
(31045, 3040, 23717, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:39:56', '2021-03-30 12:39:56');
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
(31046, 9057, 23717, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:40', '2021-05-26 13:36:40'),
(31047, 1006, 23717, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:19', '2021-06-11 14:33:19'),
(31048, 1006, 23717, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:27', '2021-06-25 11:04:27'),
(31049, 1006, 23718, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:08', '2021-03-25 11:33:08'),
(31050, 3040, 23718, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:39:25', '2021-03-30 12:39:25'),
(31051, 9057, 23718, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:49', '2021-05-26 13:36:49'),
(31052, 1006, 23718, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:15', '2021-06-11 14:33:15'),
(31053, 1006, 23718, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:24', '2021-06-25 11:04:24'),
(31054, 1006, 23719, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:09', '2021-03-25 11:33:09'),
(31055, 3040, 23719, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:38:16', '2021-03-30 12:38:16'),
(31056, 9057, 23719, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:36:55', '2021-05-26 13:36:55'),
(31057, 1006, 23719, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:12', '2021-06-11 14:33:12'),
(31058, 1006, 23719, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:22', '2021-06-25 11:04:22'),
(31059, 1006, 23720, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:33:10', '2021-03-25 11:33:10'),
(31060, 3040, 23720, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Email sent to: Providers@healthwestonline.com  Subject: Location Addition || Statcare Minor Emergency Clinic || Providers || Healthwest ||  Greetings,   Hope you are doing well. I wanted to add the providers in the Healthwest for our group Statcare Minor Emergency Clinic under the below locations.  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415   Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Additional Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-30 12:38:36', '2021-03-30 12:38:36'),
(31061, 9057, 23720, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We Sent an email to providers@healthwestonline.com Sub: Enrollment & Additional location status request - RHC - Healthwest  Hello,  We submitted a request for the enrollment & Location addition of providers under the following group  Practice Detail: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 6: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 7: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 8: Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update me with the status of the above request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 13:37:02', '2021-05-26 13:37:02'),
(31062, 1006, 23720, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent a new f/u email @ kathy@healthwestonline.com & Providers@healthwestonline.com:   Sub: Enrollment Status/Location Addition - RHC - Healthwest  \"Hello,   I hope you\'re doing well, I wanted to check in on the enrollment status for the following group and providers as well as the mentioned locations, the group and provider information is as follows:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Name:Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name:Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Francis, William Robert. Provider NPI# 1457994436  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Please get back to me as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-11 14:33:09', '2021-06-11 14:33:09'),
(31063, 1006, 23720, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment. ', NULL, NULL, '2021-06-25 11:04:17', '2021-06-25 11:04:17'),
(31064, 1006, 23732, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:34:56', '2021-03-25 11:34:56'),
(31065, 3040, 23732, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:03:22', '2021-03-30 17:03:22'),
(31066, 1006, 23733, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:34:57', '2021-03-25 11:34:57'),
(31067, 3040, 23733, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:02:27', '2021-03-30 17:02:27'),
(31068, 1006, 23734, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:34:58', '2021-03-25 11:34:58'),
(31069, 3040, 23734, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:01:39', '2021-03-30 17:01:39'),
(31070, 1006, 23735, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:34:59', '2021-03-25 11:34:59'),
(31071, 3040, 23735, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:01:03', '2021-03-30 17:01:03'),
(31072, 1006, 23736, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:00', '2021-03-25 11:35:00'),
(31073, 3040, 23736, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 17:00:29', '2021-03-30 17:00:29'),
(31074, 1006, 23737, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:01', '2021-03-25 11:35:01'),
(31075, 3040, 23737, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:59:42', '2021-03-30 16:59:42'),
(31076, 1006, 23738, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:02', '2021-03-25 11:35:02'),
(31077, 3040, 23738, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:59:00', '2021-03-30 16:59:00'),
(31078, 1006, 23739, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:03', '2021-03-25 11:35:03'),
(31079, 3040, 23739, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:58:22', '2021-03-30 16:58:22'),
(31080, 1006, 23740, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:04', '2021-03-25 11:35:04'),
(31081, 3040, 23740, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:57:22', '2021-03-30 16:57:22'),
(31082, 1006, 23741, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:05', '2021-03-25 11:35:05'),
(31083, 3040, 23741, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:56:18', '2021-03-30 16:56:18'),
(31084, 1006, 23742, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:07', '2021-03-25 11:35:07'),
(31085, 3040, 23742, NULL, '2021-04-06 00:00:00.000', 'Rejected', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes', NULL, NULL, '2021-03-30 16:55:23', '2021-03-30 16:55:23'),
(31086, 1006, 23743, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:35', '2021-03-25 11:35:35'),
(31087, 1006, 23743, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:29:43', '2021-03-26 13:29:43'),
(31088, 1006, 23744, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:36', '2021-03-25 11:35:36'),
(31089, 1006, 23744, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:29:51', '2021-03-26 13:29:51'),
(31090, 1006, 23745, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:37', '2021-03-25 11:35:37'),
(31091, 1006, 23745, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:29:57', '2021-03-26 13:29:57'),
(31092, 1006, 23746, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:38', '2021-03-25 11:35:38'),
(31093, 1006, 23746, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:05', '2021-03-26 13:30:05'),
(31094, 1006, 23747, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:39', '2021-03-25 11:35:39'),
(31095, 1006, 23747, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:11', '2021-03-26 13:30:11'),
(31096, 1006, 23748, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:40', '2021-03-25 11:35:40'),
(31097, 1006, 23748, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:17', '2021-03-26 13:30:17'),
(31098, 1006, 23749, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:41', '2021-03-25 11:35:41'),
(31099, 1006, 23749, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:23', '2021-03-26 13:30:23'),
(31100, 1006, 23750, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:41', '2021-03-25 11:35:41'),
(31101, 1006, 23750, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:30', '2021-03-26 13:30:30'),
(31102, 1006, 23751, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:42', '2021-03-25 11:35:42'),
(31103, 1006, 23751, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:40', '2021-03-26 13:30:40'),
(31104, 1006, 23752, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:43', '2021-03-25 11:35:43'),
(31105, 1006, 23752, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:46', '2021-03-26 13:30:46'),
(31106, 1006, 23753, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:35:44', '2021-03-25 11:35:44'),
(31107, 1006, 23753, NULL, '2021-04-02 00:00:00.000', 'Not Eligible', 'TCHP enrollment is not possible as our clinics do not fall under the TCHP operating area, the map can be found @ https://www.texaschildrenshealthplan.org/for-providers/becoming-a-participating-provider.   It is also attached for reference.  ', NULL, NULL, '2021-03-26 13:30:52', '2021-03-26 13:30:52'),
(31108, 1006, 23754, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-25 11:36:47', '2021-03-25 11:36:47'),
(31109, 1006, 23754, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\" ', NULL, NULL, '2021-04-08 18:15:24', '2021-04-08 18:15:24'),
(31110, 9057, 23754, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:16:50', '2021-05-25 16:16:50'),
(31111, 1006, 23754, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:45:28', '2021-06-11 16:45:28'),
(31112, 1006, 23754, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 09:35:41', '2021-06-30 09:35:41'),
(31113, 1006, 23754, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-09 17:14:06', '2021-08-09 17:14:06'),
(31114, 1006, 23754, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:48:02', '2021-08-24 14:48:02'),
(31115, 11056, 23754, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:12:16', '2021-09-21 16:12:16'),
(31116, 11056, 23754, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:48:03', '2021-10-01 12:48:03'),
(31117, 11056, 23754, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:55:42', '2021-10-18 15:55:42'),
(31118, 11056, 23754, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 12:04:10', '2021-10-26 12:04:10'),
(31119, 11056, 23754, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:29:27', '2021-11-11 14:29:27');
