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
(22684, 1019, 22161, NULL, '2021-06-21 00:00:00.000', 'Not Eligible', 'Spoken to Rep Ian, the provider is linked to our group under supervisory protocol. So we can billed under Supervisory protocol. Call Ref: IAN I- 06/09/2021 - (877) 614-0484', NULL, NULL, '2021-06-14 07:26:03', '2021-06-14 07:26:03'),
(22685, 3046, 22162, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:03', '2021-03-16 14:09:03'),
(22686, 1005, 22162, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:45:04', '2021-03-25 14:45:04'),
(22687, 3046, 22163, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:04', '2021-03-16 14:09:04'),
(22688, 1005, 22163, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:46:21', '2021-03-25 14:46:21'),
(22689, 3046, 22164, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:07', '2021-03-16 14:09:07'),
(22690, 1005, 22164, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:46:16', '2021-03-25 14:46:16'),
(22691, 3046, 22165, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:09', '2021-03-16 14:09:09'),
(22692, 1005, 22165, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:51:03', '2021-03-25 14:51:03'),
(22693, 3046, 22166, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:11', '2021-03-16 14:09:11'),
(22694, 1005, 22166, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:47:04', '2021-03-25 14:47:04'),
(22695, 3046, 22167, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:13', '2021-03-16 14:09:13'),
(22696, 1005, 22167, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:46:59', '2021-03-25 14:46:59'),
(22697, 3046, 22168, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:15', '2021-03-16 14:09:15'),
(22698, 1005, 22168, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:47:09', '2021-03-25 14:47:09'),
(22699, 3046, 22169, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:09:17', '2021-03-16 14:09:17'),
(22700, 1005, 22169, NULL, '2021-04-01 00:00:00.000', 'Approved', 'Provider\'s benefits got reassigned to the group.', NULL, NULL, '2021-03-25 14:47:15', '2021-03-25 14:47:15'),
(22701, 1006, 22170, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:10:50', '2021-03-16 14:10:50'),
(22702, 1006, 22170, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following update from Aetna on the physician group contract:  \"Good afternoon, can you please complete the roster for this group?\"', NULL, NULL, '2021-03-22 09:33:44', '2021-03-22 09:33:44'),
(22703, 1006, 22170, NULL, '2021-03-29 00:00:00.000', 'In Process', 'The roster has been filled out and sent to So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com. Attached for reference.  ', NULL, NULL, '2021-03-22 09:50:58', '2021-03-22 09:50:58'),
(22704, 1006, 22170, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: FW: [EXTERNAL] Your signature is required on TX_PhysicianGroup_100%AMFS-AMMFSwithMids85%_Right Step Medical Center LLC  \"Hello,   I hope that you\'re doing well, I wanted to get an update on the status of enrollment for our group & providers.   Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-04-05 16:29:15', '2021-04-05 16:29:15'),
(22705, 1006, 22170, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Called Aetna, was informed to reach out to the email that we sent a roster to for better updates.   Ref# 6015065079  Sent email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:   Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,  I wanted to get an update regarding the enrollment status for our group and providers, their information is as follows:  Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  I was informed that the group is showing up with the provider\'s NPI instead, could you please verify how we can correct this?  Thank you. \"', NULL, NULL, '2021-04-23 14:23:46', '2021-04-23 14:23:46'),
(22706, 1006, 22170, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent another f/u email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Good morning,  I want to follow-up on the status of my enrollment for the following group and providers:Group Name: Right Step Medical Center LLC NPI# 1063008084  Provider Name: Shybi Varghese NPI# 1285270991  Provider Name: Ramegowda Belakere NPI# 1235166687  Provider Name: Glory Abraham NPI# 1194206490  Please get back to me as soon as possible as this request has been ongoing for more than 2 months without any updates from Aetna.  Thank you. \"', NULL, NULL, '2021-05-03 07:46:02', '2021-05-03 07:46:02'),
(22707, 1006, 22170, NULL, '2021-06-02 00:00:00.000', 'In Process', 'As per my discussion with Aetna representative (Roy), we need to send W9 for Ramegowda @ ATTN: Provider Relations and fax# 859-455-8650. W9 was faxed over. ', NULL, NULL, '2021-05-26 09:29:46', '2021-05-26 09:29:46'),
(22708, 1006, 22170, NULL, '2021-06-21 00:00:00.000', 'In Process', 'Received following reply from So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com :  Sub: Provider Enrollment Query - RSM - Aetna   \"Hello Brad, I am sorry for the delay as I have been transitioning to another department. Your providers are loaded to the TIN however it appears the group was not loaded as a group in which I have requested the change. You should be good with claims but I needed the group to show as a group. If you like you can reach out to 888-632-3862 to confirm in a few weeks. Thanks\"  Need to allow more time for it to process. ', NULL, NULL, '2021-06-11 09:27:11', '2021-06-11 09:27:11'),
(22709, 1006, 22170, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I have words with Ms. Julie about the enrollment process. She said us to fill out the online application form again but when we fill-up the form again the site responded to us that we are already an existing member of it.', NULL, NULL, '2021-06-30 16:52:56', '2021-06-30 16:52:56'),
(22710, 1006, 22170, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Sent f/u email @ So TX Network Management 25WS SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,   As per my discussion with the Aetna representative on the given number they still do not see the group or providers listed, please get back to me on the status of this request as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-27 16:49:47', '2021-07-27 16:49:47'),
(22711, 1006, 22170, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Sent f/u email @ SoTXNetworkManagement25WS@aetna.com:  Sub: Provider Enrollment Query - RSM - Aetna  \"Hello,   We are still waiting on the status of this request as soon as possible, we still have not received any response on this for quite some time.  Thank you. \"', NULL, NULL, '2021-08-10 16:40:28', '2021-08-10 16:40:28'),
(22712, 1006, 22170, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Requested Aetna rep to get our enrollment request forwarded to management.  Ref# NAF454645 Rep: Jelo ', NULL, NULL, '2021-08-31 14:05:57', '2021-08-31 14:05:57'),
(22713, 11056, 22170, NULL, '2021-09-15 00:00:00.000', 'In Process', 'I have words with rep. She provide the below mentioned details.  Call rep. : MARS R REF CODE. : Hang up the call deliberately  The participation is out of network but still working to bring in network.  Application ticket no. : NAF454645 ', NULL, NULL, '2021-09-08 10:21:24', '2021-09-08 10:21:24'),
(22714, 11056, 22170, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Rep. Name : Theresa  R. & Mae D  Status : Reviewed by network team & Uploading the participation status .  Ref code no. : 92424  Phone no. : 800-353-1232  Application ticket no. : NAF454645', NULL, NULL, '2021-09-17 09:13:24', '2021-09-17 09:13:24'),
(22715, 11056, 22170, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Amby J  Ramegowda = under process for loading and linking Shybi = In network and linked to the TIN Glory = getting loaded under process Group = will be loaded after the providers contracting immediately.  Also in network.  Eff date will be : 05/15/2021  May be completed in the 1st week or 2nd week of october  Contract has been provided to credentialing for uploading the system.  Ref code : 6044414296  Contact no. : 800-353-1232', NULL, NULL, '2021-09-23 17:02:50', '2021-09-23 17:02:50'),
(22716, 11056, 22170, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Signed Agreement has been received. Please see the attachment. ', NULL, NULL, '2021-10-04 12:17:20', '2021-10-04 12:17:20'),
(22717, 11056, 22170, NULL, '2021-10-11 00:00:00.000', 'In Process', 'Rep. : Jesse R  Status :   Showing out of network. Request Stiil in process network statrted loading provider 09/09/2021  Case no. : 1679009  Ref code : 6046707646  Contact no. : 800-353-1232 ', NULL, NULL, '2021-10-04 12:33:56', '2021-10-04 12:33:56'),
(22718, 11056, 22170, NULL, '2021-10-20 00:00:00.000', 'In Process', 'Rep :  Rick N  Status : Ramegowda & Glory request is in received to link and load. Still in processing   created on : 10/10/2021 30 business days.  Case no. : 17559543  Ref code : 6049980343  contact no : 800-353-1232', NULL, NULL, '2021-10-13 13:05:35', '2021-10-13 13:05:35'),
(22719, 11056, 22170, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Rep : Jam P  Status :  Process is completed. Loaded on the system and linked with the tax ID Future effective date is 11/01/2021   Ref code. : 6051507347  contact no : 800-353-1232  ', NULL, NULL, '2021-10-21 10:58:54', '2021-10-21 10:58:54'),
(22720, 11056, 22170, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Rep:  Mark L  Status:  The group is in-network. Going to provide welcome letters in 10 business days for the providers.  Ref code: 6054022733  contact no : 800-353-1232', NULL, NULL, '2021-11-01 10:27:05', '2021-11-01 10:27:05'),
(22721, 11056, 22170, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Rep : Vinz  S   Status: In-network case properly started in 9/15/21 ticket# NAF454645 Welcome letters are expected in the next week. The future effective date is 11/01/2021  Refcode: 6057564480', NULL, NULL, '2021-11-11 15:17:58', '2021-11-11 15:17:58'),
(22722, 11056, 22170, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:26', '2021-11-18 12:01:26'),
(22723, 11056, 22170, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Cris S  Status:  Ramegowda Belakere: The application is in process. Needs around 30-40 days more.  Glory Abraham: completed. In-network  Refcode:  6058727694', NULL, NULL, '2021-11-18 12:01:27', '2021-11-18 12:01:27'),
(22724, 11056, 22170, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Rep: Dori M  Status: Case has been escalated. Ramegowda is in credentialing process. Glory Abraham case is missing by their side. LOI had to be sent to add this provider.  Case no.: 13547054  Ref code: 6059846680', NULL, NULL, '2021-11-24 18:06:50', '2021-11-24 18:06:50'),
(22725, 11056, 22170, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Rep: Arianne E   Status: Applications are still in process. Welcome letters can be expected soon.   Refcode: 11302021Ariannee', NULL, NULL, '2021-11-30 17:32:29', '2021-11-30 17:32:29'),
(22726, 11056, 22170, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Rep: Mark C  Status:  11/1/2021 linked and credentialed under the facility TIN.  Plans:  Aetna Medicare Aetna Medicaid  Refcode: 6062355331', NULL, NULL, '2021-12-08 12:38:55', '2021-12-08 12:38:55'),
(22727, 11056, 22170, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Rep: Gelo C   Status:Fully loaded in the system.Gonna receive soon a welcome letter  Ref code: 6065804152', NULL, NULL, '2021-12-22 13:48:41', '2021-12-22 13:48:41'),
(22728, 19067, 22170, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||   Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following provider with Aetna.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12, Stafford, TX 77477   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:05:32', '2021-12-28 15:05:32'),
(22729, 19067, 22170, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: Laura.Bevin@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||  Hello,  Hope you are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Aetna.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12, Stafford, TX 77477 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12, Stafford, TX 77477   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-28 15:06:31', '2021-12-28 15:06:31'),
(22730, 20067, 22170, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: Machado-PetryS@aetna.com  Subject:  Enrollment Status || RSM || Group & Provider || Aetna ||   Good Afternoon, Hope you had a great day. I would like to know the enrollment status of the below-mentioned Group and providers under Right Step Medical Center LLC.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Primary Location	11925 Southwest Freeway, Suite# 12, Stafford, TX 77477-2300 Provider Name	NPI Ancy Kurian	1316558935 Ramegowda Belakere	1235166687 Glory Abraham	1194206490  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-06 17:22:08', '2022-01-06 17:22:08'),
(22731, 19067, 22170, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email received from: Machado-PetryS@aetna.com  Subject: Enrollment Status || RSM || Group & Provider || Aetna ||    Syed,  We do not have a group agreement to add these providers currently, we do not complete group agreements with only mid-level providers staffed.  I see however, in this request you have submitted includes a physician that was not submitted previously, I will need to send you a group agreement before any providers can be added, please make sure the group owner signs the agreement.     In the future, any request you submit to add providers will need to be submitted as our process is to submit online through the provider portal here.', NULL, NULL, '2022-01-25 13:14:59', '2022-01-25 13:14:59'),
(22732, 19067, 22170, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  Still waiting to get the group agreement from your side.   Kindly respond as per your convenience.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:53:29', '2022-02-08 11:53:29'),
(22733, 19067, 22170, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||    Hello!  I have updated the agreement, Kindly look into it.  Regards.', NULL, NULL, '2022-02-18 11:41:53', '2022-02-18 11:41:53'),
(22734, 19067, 22170, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi Sylvia,  Did you receive the signed agreement? Kindly respond timely.  Regards, Hammad.', NULL, NULL, '2022-03-11 09:53:20', '2022-03-11 09:53:20'),
(22735, 22077, 22170, NULL, '2022-04-11 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Fwd: [EXTERNAL] Enrollment Status || RSM || Group & Provider || Aetna ||   Hi,  Hope this email finds you well,  Did you receive the signed agreement? kindly respond timely.  Thanks,  Alex ', NULL, NULL, '2022-04-04 09:58:43', '2022-04-04 09:58:43'),
(22736, 19067, 22170, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Re: Sylvia Machado-Petry has shared the TX03_PhysicianGroup_100%AMFS-AMMFSwithMids85%_ Right Step Medical Center LLC with you   Hi Sylvia,  I am having a problem signing the contract I think the authorized signer for this contract is Syed Ahad his email is sah@claimsmedinc.com unfortunately, he no longer works here can you make me the authorized signer for the contract so that I can sign it and get it back to you so we are already late on this process.  Also, see the attached screenshot.   Thanks, Hammad Ahmed', NULL, NULL, '2022-04-13 12:45:01', '2022-04-13 12:45:01'),
(22737, 19067, 22170, NULL, '2022-04-20 00:00:00.000', 'In Process', 'Email sent to: Machado-petrys@aetna.com  Subject: Sylvia Machado-Petry has shared the TX03_PhysicianGroup_100%AMFS-AMMFSwithMids85%_ Right Step Medical Center LLC with you    Hi Sylvia,  I am having a problem signing the contract I think the authorized signer for this contract is Syed Ahad his email is sah@claimsmedinc.com unfortunately, he no longer works here can you make me the authorized signer for the contract so that I can sign it and get it back to you as we are already late on this process.  Also, see the attached screenshot.   Thanks, Hammad Ahmed', NULL, NULL, '2022-04-13 12:50:51', '2022-04-13 12:50:51'),
(22738, 19067, 22170, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Signed the agreement. ', NULL, NULL, '2022-04-14 09:36:29', '2022-04-14 09:36:29'),
(22739, 3046, 22182, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:32', '2021-03-16 14:16:32'),
(22740, 3040, 22182, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.  ', NULL, NULL, '2021-03-30 14:38:07', '2021-03-30 14:38:07'),
(22741, 3046, 22183, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:33', '2021-03-16 14:16:33'),
(22742, 3040, 22183, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider.', NULL, NULL, '2021-03-30 14:40:20', '2021-03-30 14:40:20'),
(22743, 3046, 22184, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:35', '2021-03-16 14:16:35'),
(22744, 3040, 22184, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider.   ', NULL, NULL, '2021-03-30 14:43:27', '2021-03-30 14:43:27'),
(22745, 3046, 22185, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:36', '2021-03-16 14:16:36'),
(22746, 3040, 22185, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:46:38', '2021-03-30 14:46:38'),
(22747, 3046, 22186, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:38', '2021-03-16 14:16:38'),
(22748, 3040, 22186, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-30 14:48:59', '2021-03-30 14:48:59'),
(22749, 3046, 22187, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:39', '2021-03-16 14:16:39'),
(22750, 3040, 22187, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to individual provider. ', NULL, NULL, '2021-03-30 14:51:13', '2021-03-30 14:51:13'),
(22751, 3046, 22188, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:41', '2021-03-16 14:16:41'),
(22752, 3040, 22188, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.  ', NULL, NULL, '2021-03-30 14:58:38', '2021-03-30 14:58:38'),
(22753, 3046, 22189, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:43', '2021-03-16 14:16:43'),
(22754, 3040, 22189, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.  ', NULL, NULL, '2021-03-30 15:01:26', '2021-03-30 15:01:26'),
(22755, 3046, 22190, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:45', '2021-03-16 14:16:45'),
(22756, 3040, 22190, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Group has ancillary contract. No need to add the individual provider.', NULL, NULL, '2021-03-30 15:02:46', '2021-03-30 15:02:46'),
(22757, 3046, 22191, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:16:47', '2021-03-16 14:16:47'),
(22758, 3040, 22191, NULL, '2021-04-06 00:00:00.000', 'Approved', ' Group has ancillary contract. No need to add the individual provider.    ', NULL, NULL, '2021-03-30 15:05:08', '2021-03-30 15:05:08'),
(22759, 3040, 22192, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:17:11', '2021-03-16 14:17:11'),
(22760, 3040, 22192, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Hello, Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Stephen, Ani Provider NPI# 1588959118  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-03-16 14:19:09', '2021-03-16 14:19:09'),
(22761, 3040, 22192, NULL, '2021-06-09 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Enrollment Status || Stephen, Ani || Normandy Urgent Care Center || Ambetter ||  Hello,  Hope you are doing well. This is a follow up regarding the enrollment status of the below mentioned provider.   Practice 1: Practice Name: Normandy Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice 2: Practice Name: Imperial Valley Urgent Care Center Practice Tax-ID: 27-0796429 Practice NPI# 1407171077 Practice Address: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Information: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please feel free to contact me if you have any questions. Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-02 14:45:15', '2021-06-02 14:45:15'),
(22762, 3040, 22192, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Effective date 06/01/2021', NULL, NULL, '2021-06-21 16:43:11', '2021-06-21 16:43:11'),
(22763, 1006, 22193, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:17:47', '2021-03-16 14:17:47'),
(22764, 1006, 22193, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Ramegowda - Cigna ID# 8912478 Ram Application# 12540899 Requested a group contract as UC contract is taking too long and we haven\'t received any follow-ups from psscentral@cigna.com. Request can take up to 30~45 business days.  ', NULL, NULL, '2021-03-24 13:08:27', '2021-03-24 13:08:27'),
(22765, 1006, 22193, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ OnboardingStatus@Cigna.com & psscentral@cigna.com:  Sub: Enrollment Status - RSM - Cigna  \"Hello,   I wanted to get an update regarding the enrollment status of our group and providers, their information is as follows: Group Name: Right Step Medical Center TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.   Thank you.\"', NULL, NULL, '2021-04-05 16:49:29', '2021-04-05 16:49:29'),
(22766, 1006, 22193, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Re:	Reference number 12540919 Application to participate in the Cigna medical network Dear GLORY ABRAHAM,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna', NULL, NULL, '2021-05-03 07:49:13', '2021-05-03 07:49:13'),
(22767, 1006, 22193, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Dear GLORY ABRAHAM MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 03/24/2021. Your provider identification number is‍ ‌4048834. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-05-07 14:22:27', '2021-05-07 14:22:27'),
(22768, 1006, 22194, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:17:48', '2021-03-16 14:17:48'),
(22769, 1006, 22194, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Ramegowda - Cigna ID# 8912478 Ram Application# 12540899 Requested a group contract as UC contract is taking too long and we haven\'t received any follow-ups from psscentral@cigna.com. Request can take up to 30~45 business days.  ', NULL, NULL, '2021-03-24 13:08:19', '2021-03-24 13:08:19'),
(22770, 1006, 22194, NULL, '2021-04-01 00:00:00.000', 'In Process', 'Received the following response from Cigna Provider Onboarding ONBEloquaNotice@cigna.com:  \"Reference number 12540899 Application to participate in the Cigna medical network Dear BELAKERE RAMEGOWDA,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely, Cigna\"', NULL, NULL, '2021-03-25 08:30:48', '2021-03-25 08:30:48'),
(22771, 1006, 22194, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ OnboardingStatus@Cigna.com & psscentral@cigna.com:  Sub: Enrollment Status - RSM - Cigna  \"Hello,   I wanted to get an update regarding the enrollment status of our group and providers, their information is as follows: Group Name: Right Step Medical Center TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.   Thank you.\"', NULL, NULL, '2021-04-05 16:49:25', '2021-04-05 16:49:25'),
(22772, 1006, 22194, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Re:	Reference number 12540899 Application to participate in the Cigna medical network Dear BELAKERE RAMEGOWDA,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna', NULL, NULL, '2021-05-03 07:49:36', '2021-05-03 07:49:36'),
(22773, 1006, 22194, NULL, '2021-06-02 00:00:00.000', 'Approved', 'Provider: Ramegowda Belakere Eff: 12/01/2020 Provider# 8912478  Ref# Ivan C 05/26/2021', NULL, NULL, '2021-05-26 11:04:10', '2021-05-26 11:04:10'),
(22774, 1006, 22195, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:17:49', '2021-03-16 14:17:49'),
(22775, 1006, 22195, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Ramegowda - Cigna ID# 8912478 Ram Application# 12540899 Requested a group contract as UC contract is taking too long and we haven\'t received any follow-ups from psscentral@cigna.com. Request can take up to 30~45 business days.  ', NULL, NULL, '2021-03-24 13:08:36', '2021-03-24 13:08:36'),
(22776, 1006, 22195, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Sent a follow-up email @ OnboardingStatus@Cigna.com & psscentral@cigna.com:  Sub: Enrollment Status - RSM - Cigna  \"Hello,   I wanted to get an update regarding the enrollment status of our group and providers, their information is as follows: Group Name: Right Step Medical Center TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as you\'re able.   Thank you.\"', NULL, NULL, '2021-04-05 16:49:36', '2021-04-05 16:49:36'),
(22777, 1006, 22195, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Re:	Reference number 12540907 Application to participate in the Cigna medical network Dear SHYBI VARGHESE,  Thank you for submitting an application to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna', NULL, NULL, '2021-05-03 07:48:48', '2021-05-03 07:48:48'),
(22778, 1006, 22195, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Received the following update from Cigna @ Cigna Provider Onboarding Status 9psscent@cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"Reference number 12540907 Application complete: Credentialing process to begin Dear SHYBI VARGHESE,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-05-05 09:47:27', '2021-05-05 09:47:27'),
(22779, 1006, 22195, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Shybi Varghese The request is still in-process, need to allow more time.  App# 12540907 Ref# Ivan C 05/26/2021', NULL, NULL, '2021-05-26 11:28:49', '2021-05-26 11:28:49'),
(22780, 1006, 22195, NULL, '2021-06-08 00:00:00.000', 'In Process', 'We received the following update from Cigna:  Sub: RE: [External] Enrollment Status - RSM - Cigna  \"Thank you for contacting Cigna.  Our records indicate your providers credentialing status under the below tax id(s). If you have any additional questions, please visit our website at www.cignaforhcp.com or contact the Provider Services Unit at 800.882.4462.     Provider Name: Ramegowda Belakere-------------effective 12/01/20 cigna id 8912478  Ref# 12540899     Provider Name: Glory Abraham---------------------effective 03/24/21 cigna id 4048834  Ref# 12540919     Provider Name: Shybi Varghese---------------------application is still processing  Ref# 12540907     **Red C**  Provider Service Unit  T: 800.882.4462  Please visit our dedicated provider COVID-19 resource page on CignaforHCP.com for the most current billing and virtual care guidance, resources, FAQs, and more.  Confidential, unpublished property of Cigna. Do not duplicate or distribute. Use and distribution limited solely to authorized personnel. Copyright 2020 Cigna\"', NULL, NULL, '2021-06-01 10:05:25', '2021-06-01 10:05:25'),
(22781, 1006, 22195, NULL, '2021-06-28 00:00:00.000', 'Approved', 'Dear SHYBI VARGHESE MSN,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live a healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 06/04/2021. Your provider identification number is‍ ‌0334242. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).  ', NULL, NULL, '2021-06-21 11:02:41', '2021-06-21 11:02:41'),
(22782, 1006, 22196, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:18:07', '2021-03-16 14:18:07'),
(22783, 1006, 22196, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted a new LOI with different group specialty mentioned for enrollment purposes @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Hello,   Please find the attached LOI for enrollment of our group & providers, please let me know if anything else is required.  Thank you. \"  Attached for reference. ', NULL, NULL, '2021-04-02 11:50:08', '2021-04-02 11:50:08'),
(22784, 1006, 22196, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Good morning,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers and group:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible on the status of these.  Thank you. \"', NULL, NULL, '2021-05-03 08:14:30', '2021-05-03 08:14:30'),
(22785, 1006, 22196, NULL, '2021-05-14 00:00:00.000', 'Not Eligible', 'Humana replied with the following rejection again:  \"Dear Provider,  This letter serves as notice of denial of participation with Humana Health Plans of Texas, Humana Insurance Company, Inc and ChoiceCare.  An analysis to determine if your services and specialty would complement our existing network was performed. The analysis process involves a review of network requirements, specialty needs, and geographical considerations. As a result of the analysis, we regret that we are unable to extend a participation agreement for Right Step Medical Center LLC. Please note that all requests are considered active for one year.  Our office will contact you should our network requirements change during this period.  Please contact Michelle Horton at 713-513-4943 with any questions regarding this process.  Sincerely,  Matthew White,  Contracting Director, Provider Development, Houston\"', NULL, NULL, '2021-05-07 14:14:30', '2021-05-07 14:14:30'),
(22786, 19067, 22196, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana   Hello, Hope you had a nice weekend. I would like to enroll this group as In-Network with Humana. Group NameRight Step Medical Center LLCTax ID85-3252700 Group NPI1063008084Practice Location11925 Southwest Freeway, Suite 12 Stafford, TX 77477Provider NameNPIAni Stephen1588959118Ramegowda Belakere1235166687Glory Abraham1194206490Shybi Varghese1285270991Ancy Kurian1316558935  W9 is attached as well. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 17:05:13', '2021-12-20 17:05:13'),
(22787, 19067, 22196, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status || Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:12:48', '2021-12-29 14:12:48'),
(22788, 19067, 22196, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana  Thank you for your interest in joining Humana as a participating provider.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster, listing each service location on a separate line.     Please make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Completion of this information is not a guarantee of participation. Look forward to receiving your documents for review and determination.     HumanaHoustonPD', NULL, NULL, '2022-01-06 18:01:03', '2022-01-06 18:01:03'),
(22789, 19067, 22196, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Group & Provider || RSM || Humana   Greetings!  Hope this email finds you well.  Kindly see the attached Roster and W9 as requested.  Don\'t hesitate to contact me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 14:27:08', '2022-01-25 14:27:08'),
(22790, 19067, 22196, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.', NULL, NULL, '2022-02-08 16:28:03', '2022-02-08 16:28:03'),
(22791, 19067, 22196, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Good morning Hammad,  2 providers on your roster will need credentialing and each will need updates to their CAQH information. Please note the following:  Ancy Kurian – CAQH is not complete.  Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.   ', NULL, NULL, '2022-02-18 11:51:09', '2022-02-18 11:51:09'),
(22792, 19067, 22196, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Thanks for the update.   Shybi Varghese & Ancy Kurian\'s CAQH has been updated.   If you need any document or information don\'t hesitate to reach out to me directly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 10:53:50', '2022-02-24 10:53:50'),
(22793, 19067, 22196, NULL, '2022-03-14 00:00:00.000', 'In Process', 'Secure email received from: HumanaHoustonPD@humana.com  Subject: RE: Enrollment Query || Group & Provider || RSM || Humana    Your request has been in process for over 60 days (since 12/20/21) and the necessary information has not been supplied.     Shybi Varghese’s CAQH record still does not have a proper state license posted.  Ancy  Kurian is non par for Medicare and does not have full hospital privileges listed in the Provider Profile.  Humana’s credentialing department only uses CAQH, therefore these items must be updated and reflecting in CAQH.  This market office will not submit your request in this incomplete condition for credentialing as the providers will be denied.  Once denied, the process to resubmit becomes complicated.      If this information isn’t supplied and resolved by 2/28/2022, the file will be permanently closed and a new application will be required.  As always, it is the responsibility of the applicant to notify us if/when this is addressed as we do not audit applicants for follow up actions.     Thank you for your immediate attention to this matter,     HumanaHoustonPD   ', NULL, NULL, '2022-03-07 13:36:22', '2022-03-07 13:36:22'),
(22794, 1006, 22197, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:18:08', '2021-03-16 14:18:08'),
(22795, 1006, 22197, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted a new LOI with different group specialty mentioned for enrollment purposes @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Hello,   Please find the attached LOI for enrollment of our group & providers, please let me know if anything else is required.  Thank you. \"  Attached for reference. ', NULL, NULL, '2021-04-02 11:50:20', '2021-04-02 11:50:20'),
(22796, 1006, 22197, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Good morning,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers and group:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible on the status of these.  Thank you. \"', NULL, NULL, '2021-05-03 08:14:27', '2021-05-03 08:14:27'),
(22797, 1006, 22197, NULL, '2021-05-14 00:00:00.000', 'Not Eligible', 'Humana replied with the following rejection again:  \"Dear Provider,  This letter serves as notice of denial of participation with Humana Health Plans of Texas, Humana Insurance Company, Inc and ChoiceCare.  An analysis to determine if your services and specialty would complement our existing network was performed. The analysis process involves a review of network requirements, specialty needs, and geographical considerations. As a result of the analysis, we regret that we are unable to extend a participation agreement for Right Step Medical Center LLC. Please note that all requests are considered active for one year.  Our office will contact you should our network requirements change during this period.  Please contact Michelle Horton at 713-513-4943 with any questions regarding this process.  Sincerely,  Matthew White,  Contracting Director, Provider Development, Houston\"', NULL, NULL, '2021-05-07 14:14:35', '2021-05-07 14:14:35'),
(22798, 19067, 22197, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana   Hello, Hope you had a nice weekend. I would like to enroll this group as In-Network with Humana. Group NameRight Step Medical Center LLCTax ID85-3252700 Group NPI1063008084Practice Location11925 Southwest Freeway, Suite 12 Stafford, TX 77477Provider NameNPIAni Stephen1588959118Ramegowda Belakere1235166687Glory Abraham1194206490Shybi Varghese1285270991Ancy Kurian1316558935  W9 is attached as well. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 17:05:08', '2021-12-20 17:05:08'),
(22799, 19067, 22197, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status || Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:12:42', '2021-12-29 14:12:42'),
(22800, 19067, 22197, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana  Thank you for your interest in joining Humana as a participating provider.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster, listing each service location on a separate line.     Please make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Completion of this information is not a guarantee of participation. Look forward to receiving your documents for review and determination.     HumanaHoustonPD', NULL, NULL, '2022-01-06 18:00:58', '2022-01-06 18:00:58'),
(22801, 19067, 22197, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Group & Provider || RSM || Humana   Greetings!  Hope this email finds you well.  Kindly see the attached Roster and W9 as requested.  Don\'t hesitate to contact me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 14:27:03', '2022-01-25 14:27:03'),
(22802, 19067, 22197, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.', NULL, NULL, '2022-02-08 16:27:58', '2022-02-08 16:27:58'),
(22803, 19067, 22197, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Good morning Hammad,  2 providers on your roster will need credentialing and each will need updates to their CAQH information. Please note the following:  Ancy Kurian – CAQH is not complete.  Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.   ', NULL, NULL, '2022-02-18 11:51:03', '2022-02-18 11:51:03');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(22804, 19067, 22197, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Thanks for the update.   Shybi Varghese & Ancy Kurian\'s CAQH has been updated.   If you need any document or information don\'t hesitate to reach out to me directly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 10:50:23', '2022-02-24 10:50:23'),
(22805, 19067, 22197, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email received from: noreply@onlinesecuremail.com  Subject: RE: Enrollment Query || Group & Provider || RSM || Humana    Your request has been in process for over 60 days (since 12/20/21) and the necessary information has not been supplied.     Shybi Varghese’s CAQH record still does not have a proper state license posted.  Ancy  Kurian is non par for Medicare and does not have full hospital privileges listed in the Provider Profile.  Humana’s credentialing department only uses CAQH, therefore these items must be updated and reflecting in CAQH.  This market office will not submit your request in this incomplete condition for credentialing as the providers will be denied.  Once denied, the process to resubmit becomes complicated.      If this information isn’t supplied and resolved by 2/28/2022, the file will be permanently closed and a new application will be required.  As always, it is the responsibility of the applicant to notify us if/when this is addressed as we do not audit applicants for follow up actions.     Thank you for your immediate attention to this matter,     HumanaHoustonPD', NULL, NULL, '2022-03-11 13:43:52', '2022-03-11 13:43:52'),
(22806, 19067, 22197, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email sent to: HumanaHoustonPD@humana.com  Subject: Re: RE: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Shybi Varghese\'s CAQH has been updated.  Ancy Kurian is Par from Medicare. Her Medicare number is 1X8153. CAQH has been updated.  Thanks.', NULL, NULL, '2022-03-11 13:46:10', '2022-03-11 13:46:10'),
(22807, 1006, 22198, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:18:09', '2021-03-16 14:18:09'),
(22808, 1006, 22198, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Submitted a new LOI with different group specialty mentioned for enrollment purposes @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Hello,   Please find the attached LOI for enrollment of our group & providers, please let me know if anything else is required.  Thank you. \"  Attached for reference. ', NULL, NULL, '2021-04-02 11:50:32', '2021-04-02 11:50:32'),
(22809, 1006, 22198, NULL, '2021-05-19 00:00:00.000', 'In Process', 'Sent a f/u email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Letter of Interest - RSM - Humana  \"Good morning,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers and group:  Group Name: Right Step Medical Center LLC NPI# 1063008084 TIN# 85-3252700  Provider Name: Ramegowda Belakere NPI# 1235166687 Provider Name: Glory Abraham NPI# 1194206490 Provider Name: Shybi Varghese NPI# 1285270991  Please get back to me as soon as possible on the status of these.  Thank you. \"', NULL, NULL, '2021-05-03 08:14:23', '2021-05-03 08:14:23'),
(22810, 1006, 22198, NULL, '2021-05-14 00:00:00.000', 'Not Eligible', 'Humana replied with the following rejection again:  \"Dear Provider,  This letter serves as notice of denial of participation with Humana Health Plans of Texas, Humana Insurance Company, Inc and ChoiceCare.  An analysis to determine if your services and specialty would complement our existing network was performed. The analysis process involves a review of network requirements, specialty needs, and geographical considerations. As a result of the analysis, we regret that we are unable to extend a participation agreement for Right Step Medical Center LLC. Please note that all requests are considered active for one year.  Our office will contact you should our network requirements change during this period.  Please contact Michelle Horton at 713-513-4943 with any questions regarding this process.  Sincerely,  Matthew White,  Contracting Director, Provider Development, Houston\"', NULL, NULL, '2021-05-07 14:14:41', '2021-05-07 14:14:41'),
(22811, 19067, 22198, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana   Hello, Hope you had a nice weekend. I would like to enroll this group as In-Network with Humana. Group NameRight Step Medical Center LLCTax ID85-3252700 Group NPI1063008084Practice Location11925 Southwest Freeway, Suite 12 Stafford, TX 77477Provider NameNPIAni Stephen1588959118Ramegowda Belakere1235166687Glory Abraham1194206490Shybi Varghese1285270991Ancy Kurian1316558935  W9 is attached as well. Thanks & Regards,Ahmed, Hammad', NULL, NULL, '2021-12-20 17:05:01', '2021-12-20 17:05:01'),
(22812, 19067, 22198, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Enrollment Status || Providers || SNBCARE || || HUMANA ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Providers.  Group Name	Right Step Medical Center LLC Tax ID	85-3252700 Group NPI	1063008084 Provider Name	NPI	Location Ani Stephen	1588959118	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ancy Kurian	1316558935	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Glory Abraham	1194206490	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300 Ramegowda Belakere	1235166687	11925 Southwest Freeway, Suite 12 Stafford, TX 77477-2300   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 14:12:37', '2021-12-29 14:12:37'),
(22813, 19067, 22198, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: HumanaHoustonPD@humana.com  Subject: Enrollment Query || Group & Provider || RSM || Humana  Thank you for your interest in joining Humana as a participating provider.  Please complete and return the attached document, in its original excel format, along with a W-9. Include all providers in the practice that wish to participate on the professional network roster, listing each service location on a separate line.     Please make sure CAQH is updated for all providers to prevent any delays in the contracting process. Additionally, ensure that Humana is included in the “List of Authorized Organizations” in order for Humana to have on-line access to the provider’s CAQH account and the provider has granted access to Humana to view the CAQH credentialing information.     Completion of this information is not a guarantee of participation. Look forward to receiving your documents for review and determination.     HumanaHoustonPD', NULL, NULL, '2022-01-06 18:00:54', '2022-01-06 18:00:54'),
(22814, 19067, 22198, NULL, '2022-02-01 00:00:00.000', 'In Process', 'Email sent to: HumanaHoustonPD@humana.com  Subject: Re: Enrollment Query || Group & Provider || RSM || Humana   Greetings!  Hope this email finds you well.  Kindly see the attached Roster and W9 as requested.  Don\'t hesitate to contact me if you need anything.  Regards, Hammad Ahmed.', NULL, NULL, '2022-01-25 14:26:56', '2022-01-25 14:26:56'),
(22815, 19067, 22198, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.', NULL, NULL, '2022-02-08 16:27:51', '2022-02-08 16:27:51'),
(22816, 19067, 22198, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Secure email received from: MDuffee@humana.com  Subject: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana    Good morning Hammad,  2 providers on your roster will need credentialing and each will need updates to their CAQH information. Please note the following:  Ancy Kurian – CAQH is not complete.  Shybi Varghese – State License needed, Medicare information required, and full hospital privileges are needed.  In lieu of the midlevel having privilege’s,  we will accept a covering provider however it does need to be documented within CAQH.  Please notify me when all information has been updated and the documents needed are viewable.  If you have any further questions, please let me know.  Thank you.   ', NULL, NULL, '2022-02-18 11:50:58', '2022-02-18 11:50:58'),
(22817, 19067, 22198, NULL, '2022-03-03 00:00:00.000', 'In Process', 'Email sent to: MDuffee@humana.com  Subject: Re: Secured: FW: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Thanks for the update.   Shybi Varghese & Ancy Kurian\'s CAQH has been updated.   If you need any document or information don\'t hesitate to reach out to me directly.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-24 10:53:33', '2022-02-24 10:53:33'),
(22818, 19067, 22198, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email received from: noreply@onlinesecuremail.com  Subject: RE: Enrollment Query || Group & Provider || RSM || Humana    Your request has been in process for over 60 days (since 12/20/21) and the necessary information has not been supplied.     Shybi Varghese’s CAQH record still does not have a proper state license posted.  Ancy  Kurian is non par for Medicare and does not have full hospital privileges listed in the Provider Profile.  Humana’s credentialing department only uses CAQH, therefore these items must be updated and reflecting in CAQH.  This market office will not submit your request in this incomplete condition for credentialing as the providers will be denied.  Once denied, the process to resubmit becomes complicated.      If this information isn’t supplied and resolved by 2/28/2022, the file will be permanently closed and a new application will be required.  As always, it is the responsibility of the applicant to notify us if/when this is addressed as we do not audit applicants for follow up actions.     Thank you for your immediate attention to this matter,     HumanaHoustonPD', NULL, NULL, '2022-03-11 13:43:57', '2022-03-11 13:43:57'),
(22819, 19067, 22198, NULL, '2022-03-18 00:00:00.000', 'In Process', 'Secure email sent to: HumanaHoustonPD@humana.com  Subject: Re: RE: Enrollment Query || Group & Provider || RSM || Humana   Hi,  Shybi Varghese\'s CAQH has been updated.  Ancy Kurian is Par from Medicare. Her Medicare number is 1X8153. CAQH has been updated.  Thanks.', NULL, NULL, '2022-03-11 13:46:14', '2022-03-11 13:46:14'),
(22820, 19067, 22198, NULL, '2022-04-12 00:00:00.000', 'On Hold', 'Provider no longer practices @ RSM', NULL, NULL, '2022-04-05 13:05:05', '2022-04-05 13:05:05'),
(22821, 3046, 22199, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:12', '2021-03-16 14:21:12'),
(22822, 1006, 22199, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted request for address addition of SPID but also added request to add following addresses to the group:  \"MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7560925    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard  Also, add the following addresses under the group and all practitioners that are participating under the group:  Secondary Service Address: 4042 River Hill, Corpus Christi, TX 78410 Phone# 361-933-5187 Fax# 361-933-5189  Tertiary Service Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Phone# 361-334-2023 Fax# 361-334-2025\"', NULL, NULL, '2021-03-30 13:40:32', '2021-03-30 13:40:32'),
(22823, 1006, 22199, NULL, '2021-05-05 00:00:00.000', 'In Process', 'The addresses haven\'t been added to the group profile but they are added to the individual providers. Need to allow more time for group to be updated.  Ref# 7560925    ', NULL, NULL, '2021-04-28 14:09:05', '2021-04-28 14:09:05'),
(22824, 9057, 22199, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to: registrar@multiplan.com Sub: Additional location status request - RHC - Multiplan  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Group Details Group Name: Statcare Minor Emergency Clinic NPI#  1689924904 TIN#  46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Provider Details Provider Name: Capupus, Mari Provider NPI: 1740517945 Case Number: 7594352   Also we asked for the addition of below mentioned addresses to the group profile   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Case Number: 7560925   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  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you', NULL, NULL, '2021-05-26 12:04:12', '2021-05-26 12:04:12'),
(22825, 1006, 22199, NULL, '2021-06-10 00:00:00.000', 'In Process', 'Sent f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I wanted to follow up on the status of this request, have there been any updates?  Thank you.\"', NULL, NULL, '2021-06-03 14:06:57', '2021-06-03 14:06:57'),
(22826, 1006, 22199, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent another f/u email @ registrar@multiplan.com:  Sub: Additional location status request - RHC - Multiplan  \"Hello,   I hope you\'re doing well, I wanted to get an update on the status of our location addition?  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-06-21 16:08:47', '2021-06-21 16:08:47'),
(22827, 1006, 22199, NULL, '2021-07-12 00:00:00.000', 'Approved', 'The location has been added, proof of location addition is attached for reference.   Eff: 09/15/2015', NULL, NULL, '2021-07-05 14:30:23', '2021-07-05 14:30:23'),
(22828, 3046, 22200, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:46', '2021-03-16 14:21:46'),
(22829, 1006, 22200, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:12:51', '2021-03-30 16:12:51'),
(22830, 3046, 22201, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:48', '2021-03-16 14:21:48'),
(22831, 1006, 22201, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Provider enrollment request submitted as per Multiplan they were termed in 2019, email attached:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561602    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 17:00:43', '2021-03-30 17:00:43'),
(22832, 1006, 22201, NULL, '2021-05-05 00:00:00.000', 'In Process', 'Email received from noreplycustserv@multiplan.com:  Sub: Closed Customer Service Case 7561602  \"MultiPlan has closed Customer Service Case 7561602.  The resolution of your case is noted below. If you have additional questions regarding this case, please re-open the case online, add your comments, and a customer service representative will respond to your inquiry via email.  Dear Brad Peterson,  Additional information is required for Juan Miguel Capupus  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees? Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.  Case Number: 7561602    Submitter Name: Brad Peterson Date of submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard\"  Opened the case again and replied back to them regarding their queries. ', NULL, NULL, '2021-04-28 14:51:01', '2021-04-28 14:51:01'),
(22833, 1006, 22201, NULL, '2021-05-17 00:00:00.000', 'Approved', 'The provider is approved with Multiplan, a welcome letter and proof of location are attached for reference.   Eff: 03/30/2021', NULL, NULL, '2021-05-10 14:17:56', '2021-05-10 14:17:56'),
(22834, 3046, 22202, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:50', '2021-03-16 14:21:50'),
(22835, 1006, 22202, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:18:24', '2021-03-30 16:18:24'),
(22836, 3046, 22203, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:53', '2021-03-16 14:21:53'),
(22837, 1006, 22203, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:20:17', '2021-03-30 16:20:17'),
(22838, 3046, 22204, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:55', '2021-03-16 14:21:55'),
(22839, 1006, 22204, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Katherine is enrolled with Multiplan and PHCS, approval confirmation and location information is attached for reference.   MultiPlan Network 03/22/2016 - Present Product Effective Period MultiPlan	 03/22/2016 - 	Present MultiPlan Auto Medical	 03/22/2016 - 	Present MultiPlan Workers\' Compensation	 03/22/2016 - 	Present PHCS Network 02/01/2017 - Present Product Effective Period PHCS	 02/01/2017 - 	Present ', NULL, NULL, '2021-03-30 10:06:42', '2021-03-30 10:06:42'),
(22840, 3046, 22205, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:57', '2021-03-16 14:21:57'),
(22841, 1006, 22205, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'The location addition request has been submitted via Multiplan provider portal:   MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561589    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Rogers, Petina Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Update an Address    Priority: Standard ', NULL, NULL, '2021-03-30 16:45:57', '2021-03-30 16:45:57'),
(22842, 1006, 22205, NULL, '2021-05-06 00:00:00.000', 'Approved', 'The provider has been added to the location, location confirmation is attached for reference as well as a welcome letter.   Eff: 10/23/2019 ', NULL, NULL, '2021-04-29 15:18:05', '2021-04-29 15:18:05'),
(22843, 3046, 22206, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:21:59', '2021-03-16 14:21:59'),
(22844, 1006, 22206, NULL, '2021-04-06 00:00:00.000', 'Approved', 'The provider is already enrolled with Multiplan, please find the location roster & Multiplan approval.  ', NULL, NULL, '2021-03-30 16:25:18', '2021-03-30 16:25:18'),
(22845, 1006, 22206, NULL, '2021-07-27 00:00:00.000', 'Revalidation', 'Received fax from Multiplan to re-credential the provider. Information provided to them, request is attached in task for reference. ', NULL, NULL, '2021-07-20 09:37:50', '2021-07-20 09:37:50'),
(22846, 1006, 22206, NULL, '2021-08-25 00:00:00.000', 'Revalidation', 'Opened new service case for the status of re-credentialing of provider:  Service Case Number:  7711003  \"I wanted to get an update regarding the recredentialing status for the mentioned provider under our group, also the provider should be listed under the following addresses as well:  Secondary Location: 4042 River Hill, Corpus Christi, TX 78410 Tertiary Location: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Quaternary Location: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Thank you. \"', NULL, NULL, '2021-08-18 16:14:13', '2021-08-18 16:14:13'),
(22847, 1006, 22206, NULL, '2021-09-03 00:00:00.000', 'Revalidation', 'Received a recredentialing notice and emailed it @ registrar@multiplan.com. Attached for reference. ', NULL, NULL, '2021-08-27 14:08:32', '2021-08-27 14:08:32'),
(22848, 11056, 22206, NULL, '2021-09-28 00:00:00.000', 'Revalidation', 'Email sent to : registrar@multiplan.com  Sub : Recredentialing Request - Maegan Svatek  Good afternoon!  Hope all is well with you. Please provide me with the recredentialing status for the provider,Maegan Svatek ( NPI: 1639670250) under TIN (46-0575924). And also with addresses listed underneath her.  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 14:23:33', '2021-09-21 14:23:33'),
(22849, 11056, 22206, NULL, '2021-10-19 00:00:00.000', 'Revalidated', 'Rep : James D  Status : Recredentialing has been completed.  Next recredentialing date:  06/07/2024  Ref code : 7711003  All locations are listed under the provider.  please see the attachments.', NULL, NULL, '2021-10-12 10:25:49', '2021-10-12 10:25:49'),
(22850, 3046, 22207, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:22:01', '2021-03-16 14:22:01'),
(22851, 1006, 22207, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted enrollment request and group addition for provider for all addresses:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561360    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 14:30:21', '2021-03-30 14:30:21'),
(22852, 1006, 22207, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Multiplan @ PortalRegistrar PortalRegistrar@multiplan.com:  Sub: FW: Contract ID 9671500 Case # 7561360  \"Dear Brad Peterson,  Additional information is required for Rose Puentes  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees?  Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.\"  Reopened the case and submitted the answers. ', NULL, NULL, '2021-04-28 15:35:56', '2021-04-28 15:35:56'),
(22853, 1006, 22207, NULL, '2021-05-07 00:00:00.000', 'In Process', 'We received the following email from appmissinginfo fax7814878257@multiplan.com:  Sub: Regarding Trevino, Rose P., PAC\'s MultiPlan Application – Reference: APP0008202553  \"We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Sriyanka  D Provider Data Management appmissinginfo@multiplan.com  MultiPlan, Inc 16 Crosby Drive Bedford, MA 01730 Fax: 781-487-8257 Reference: APP0008202553\"  The form was filled out and sent to Multiplan.', NULL, NULL, '2021-04-30 08:28:43', '2021-04-30 08:28:43'),
(22854, 1006, 22207, NULL, '2021-05-20 00:00:00.000', 'In Process', 'We received an email from Multiplan stating that provider has a BHS degree and is unable to be credentialed but she would still be able to bill under the group contract, informed billing team to go ahead and do so. Will update task once claim status is received. ', NULL, NULL, '2021-05-10 13:39:05', '2021-05-10 13:39:05'),
(22855, 1006, 22207, NULL, '2021-07-03 00:00:00.000', 'In Process', 'Sent f/u email to billing team: \"Hello,  I wanted to check in with you to see if any claims were received and sent out for Rose Trevino yet?  Thank you.\"', NULL, NULL, '2021-06-03 10:35:29', '2021-06-03 10:35:29'),
(22856, 1006, 22207, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-06-21 16:05:59', '2021-06-21 16:05:59'),
(22857, 1006, 22207, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time. ', NULL, NULL, '2021-07-05 13:48:13', '2021-07-05 13:48:13'),
(22858, 1006, 22207, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time.  ', NULL, NULL, '2021-08-17 17:17:54', '2021-08-17 17:17:54'),
(22859, 11056, 22207, NULL, '2021-09-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-09-21 14:15:08', '2021-09-21 14:15:08'),
(22860, 11056, 22207, NULL, '2021-10-11 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-04 10:58:55', '2021-10-04 10:58:55'),
(22861, 11056, 22207, NULL, '2021-10-21 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-14 12:45:34', '2021-10-14 12:45:34'),
(22862, 11056, 22207, NULL, '2021-11-01 00:00:00.000', 'In Process', '	 We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-25 12:35:53', '2021-10-25 12:35:53'),
(22863, 11056, 22207, NULL, '2021-11-18 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-11 13:21:41', '2021-11-11 13:21:41'),
(22864, 11056, 22207, NULL, '2021-12-01 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-24 17:09:56', '2021-11-24 17:09:56'),
(22865, 11056, 22207, NULL, '2021-12-17 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-10 17:30:39', '2021-12-10 17:30:39'),
(22866, 11056, 22207, NULL, '2021-12-30 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-23 10:26:57', '2021-12-23 10:26:57'),
(22867, 19067, 22207, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:24:48', '2022-01-12 17:24:48'),
(22868, 19067, 22207, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:40', '2022-01-26 17:28:40'),
(22869, 19067, 22207, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:37:49', '2022-02-11 14:37:49'),
(22870, 19067, 22207, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:57', '2022-02-23 14:28:57'),
(22871, 19067, 22207, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:31', '2022-03-15 16:19:31'),
(22872, 3046, 22208, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:42', '2021-03-16 14:24:42'),
(22873, 1006, 22208, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations for Statcare are listed under only one PTAN.   Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 GROUP NPI	1689924904 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 09:40:19', '2021-03-26 09:40:19'),
(22874, 3046, 22209, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:44', '2021-03-16 14:24:44'),
(22875, 1006, 22209, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are already listed under group PTAN and provider is added under group.  Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PATRICK A AYARZAGOITIA NP PROVIDER PTAN	P02173892 PROVIDER NPI	1649568239 EFFECTIVE DATE	10/31/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:43:36', '2021-03-26 10:43:36'),
(22876, 3046, 22210, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:46', '2021-03-16 14:24:46'),
(22877, 1006, 22210, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, which provider is linked to.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	JUAN M CAPUPUS NP PROVIDER PTAN	P02418072 PROVIDER NPI	1891168597 EFFECTIVE DATE	07/20/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:44:58', '2021-03-26 10:44:58'),
(22878, 3046, 22211, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:47', '2021-03-16 14:24:47'),
(22879, 1006, 22211, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under group PTAN, and provider is added under group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	M A CAPUPUS PA PROVIDER PTAN	P02133478 PROVIDER NPI	1740517945 EFFECTIVE DATE	08/05/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:45:50', '2021-03-26 10:45:50'),
(22880, 3046, 22212, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:49', '2021-03-16 14:24:49'),
(22881, 1006, 22212, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are added under group PTAN and the provider is linked to the group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	TRACI SMITH MASON NP PROVIDER PTAN	P02133482 PROVIDER NPI	1497127831 EFFECTIVE DATE	08/10/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:46:52', '2021-03-26 10:46:52'),
(22882, 3046, 22213, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:51', '2021-03-16 14:24:51'),
(22883, 1006, 22213, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are listed under one PTAN for the group which providers are added under.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE C RABAGOS NP PROVIDER PTAN	P01596057 PROVIDER NPI	1134415631 EFFECTIVE DATE	04/12/2014 END DATE 	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE ', NULL, NULL, '2021-03-26 10:48:15', '2021-03-26 10:48:15'),
(22884, 3046, 22214, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:53', '2021-03-16 14:24:53'),
(22885, 1006, 22214, NULL, '2021-04-02 00:00:00.000', 'Approved', 'All locations are already listed under group PTAN and the provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	PETINA L ROGERS NP PROVIDER PTAN	P02405363 PROVIDER NPI	1801443916 EFFECTIVE DATE	10/10/2019 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:50:47', '2021-03-26 10:50:47'),
(22886, 3046, 22215, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:24:55', '2021-03-16 14:24:55'),
(22887, 1006, 22215, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Group locations are all added under group PTAN and provider is linked to group.   Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	MAEGAN J SVATEK NP PROVIDER PTAN	P02133470 PROVIDER NPI	1639670250 EFFECTIVE DATE	06/08/2018 END DATE	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	 ', NULL, NULL, '2021-03-26 10:52:32', '2021-03-26 10:52:32'),
(22888, 3046, 22216, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:33', '2021-03-16 14:27:33'),
(22889, 1006, 22216, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:25:24', '2021-03-31 15:25:24'),
(22890, 3046, 22217, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:34', '2021-03-16 14:27:34'),
(22891, 1006, 22217, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:25:29', '2021-03-31 15:25:29'),
(22892, 3046, 22218, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:36', '2021-03-16 14:27:36'),
(22893, 1006, 22218, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:25:33', '2021-03-31 15:25:33'),
(22894, 3046, 22219, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:41', '2021-03-16 14:27:41'),
(22895, 1006, 22219, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:25:38', '2021-03-31 15:25:38'),
(22896, 3046, 22220, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:43', '2021-03-16 14:27:43'),
(22897, 1006, 22220, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:10', '2021-03-31 15:26:10'),
(22898, 3046, 22221, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:46', '2021-03-16 14:27:46'),
(22899, 1006, 22221, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:23', '2021-03-31 15:26:23'),
(22900, 3046, 22222, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:48', '2021-03-16 14:27:48'),
(22901, 1006, 22222, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:28', '2021-03-31 15:26:28'),
(22902, 3046, 22223, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:50', '2021-03-16 14:27:50'),
(22903, 1006, 22223, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:32', '2021-03-31 15:26:32'),
(22904, 3046, 22224, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:52', '2021-03-16 14:27:52'),
(22905, 1006, 22224, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:37', '2021-03-31 15:26:37'),
(22906, 3046, 22225, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:55', '2021-03-16 14:27:55'),
(22907, 1006, 22225, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:42', '2021-03-31 15:26:42'),
(22908, 3046, 22226, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:27:57', '2021-03-16 14:27:57'),
(22909, 1006, 22226, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:26:47', '2021-03-31 15:26:47'),
(22910, 3046, 22227, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:29', '2021-03-16 14:31:29'),
(22911, 3040, 22227, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:48:30', '2021-04-07 13:48:30'),
(22912, 3040, 22227, NULL, '2021-04-16 00:00:00.000', 'In Process', 'I had a word with (Veronica) Superior Healthplan representative and she said we need to enroll the group and after that enroll the provider.   Ref: i53972195  ', NULL, NULL, '2021-04-09 14:15:50', '2021-04-09 14:15:50'),
(22913, 1006, 22227, NULL, '2021-06-10 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-06-03 14:07:45', '2021-06-03 14:07:45'),
(22914, 1006, 22227, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Received the following email from Superior @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com ​  Sub: [secure] RE: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health || ref#34556  \"Hello Adil,  To have the group enrolled with Superior Healthplan you would need to submit a request through our website. I have provided the link below. Every provider that will be participating and services members will need to also have a request submitted.  https://www.superiorhealthplan.com/providers/become-a-provider.html  Should you have any questions, please do let me know.  Thank you,  Patricia Torres Provider Account Manager II  SUPERIOR 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401 Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com\"   Submitted enrollment via the superior website, attached form for reference in main group tasks.', NULL, NULL, '2021-06-15 17:04:09', '2021-06-15 17:04:09'),
(22915, 11056, 22227, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Email sent to :    AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  Greetings,  Hope you are doing well. I want to inquire about the enrollment status of the group and providers. We have submitted the enrollment via the superior website on 06/15/2021. How long it will take to complete the credentialing process?  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  Please Respond soon. Waiting to hear from you soon. If you have any questions or concerns feel free to contact me.  Thank you!', NULL, NULL, '2021-07-01 15:44:26', '2021-07-01 15:44:26'),
(22916, 1006, 22227, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply from AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status Query - Superior Health - Statcare Minor Emergency Clinic  \"Good afternoon Ahmed  Can you kindly provide the following information so that way I can process your request  ·         Provider NPI#  ·         Provider TID#   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 \"  Sent following reply to them:  \"Hello,  Sure thing, the group information is as follows:  Group Name: Statcare Minor Emergency Clinic TIN# 46-0575924 NPI# 1689924904  The enrollment request was submitted back in June. Please let me know if it was received and is being processed.  Thank you.\"', NULL, NULL, '2021-07-05 16:33:44', '2021-07-05 16:33:44'),
(22917, 1006, 22227, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference. ', NULL, NULL, '2021-07-15 11:02:08', '2021-07-15 11:02:08'),
(22918, 1006, 22227, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:08', '2021-08-17 17:08:08'),
(22919, 1006, 22227, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:05', '2021-09-01 15:33:05');
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
(22920, 11056, 22227, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:59', '2021-09-22 12:05:59'),
(22921, 11056, 22227, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:08:18', '2021-09-29 17:08:18'),
(22922, 11056, 22227, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:43', '2021-10-12 14:25:43'),
(22923, 11056, 22227, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:52:07', '2021-10-20 12:52:07'),
(22924, 11056, 22227, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:29:39', '2021-11-10 17:29:39'),
(22925, 11056, 22227, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:36:50', '2021-11-19 17:36:50'),
(22926, 11056, 22227, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:47:47', '2021-12-01 12:47:47'),
(22927, 11056, 22227, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:23', '2021-12-16 16:39:23'),
(22928, 11056, 22227, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:31', '2021-12-23 15:35:31'),
(22929, 19067, 22227, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:23', '2022-01-10 18:05:23'),
(22930, 19067, 22227, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:19:52', '2022-01-26 17:19:52'),
(22931, 19067, 22227, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:52', '2022-02-11 14:54:52'),
(22932, 19067, 22227, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:56', '2022-02-21 17:32:56'),
(22933, 19067, 22227, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:55', '2022-03-15 17:47:55'),
(22934, 22077, 22227, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:40:40', '2022-04-22 14:40:40'),
(22935, 3046, 22228, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:32', '2021-03-16 14:31:32'),
(22936, 3040, 22228, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:21', '2021-04-07 13:51:21'),
(22937, 9057, 22228, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:48', '2021-05-26 15:00:48'),
(22938, 1006, 22228, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:38', '2021-06-15 17:08:38'),
(22939, 1006, 22228, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:01', '2021-07-20 10:30:01'),
(22940, 1006, 22228, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:07:23', '2021-08-17 17:07:23'),
(22941, 1006, 22228, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:32', '2021-09-01 15:33:32'),
(22942, 11056, 22228, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:54', '2021-09-22 12:05:54'),
(22943, 11056, 22228, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:08:12', '2021-09-29 17:08:12'),
(22944, 11056, 22228, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:50', '2021-10-12 14:25:50'),
(22945, 11056, 22228, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:52:16', '2021-10-20 12:52:16'),
(22946, 11056, 22228, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:29:45', '2021-11-10 17:29:45'),
(22947, 11056, 22228, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:37:35', '2021-11-19 17:37:35'),
(22948, 11056, 22228, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:47:54', '2021-12-01 12:47:54'),
(22949, 11056, 22228, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:29', '2021-12-16 16:39:29'),
(22950, 11056, 22228, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:26', '2021-12-23 15:35:26'),
(22951, 19067, 22228, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:05:15', '2022-01-10 18:05:15'),
(22952, 19067, 22228, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:19:46', '2022-01-26 17:19:46'),
(22953, 19067, 22228, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:45', '2022-02-11 14:54:45'),
(22954, 19067, 22228, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:50', '2022-02-21 17:32:50'),
(22955, 19067, 22228, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:50', '2022-03-15 17:47:50'),
(22956, 22077, 22228, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:47:12', '2022-04-22 14:47:12'),
(22957, 3046, 22229, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:33', '2021-03-16 14:31:33'),
(22958, 3040, 22229, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:40', '2021-04-07 13:51:40'),
(22959, 9057, 22229, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:00:54', '2021-05-26 15:00:54'),
(22960, 1006, 22229, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:41', '2021-06-15 17:08:41'),
(22961, 1006, 22229, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:14', '2021-07-20 10:30:14'),
(22962, 1006, 22229, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:07:42', '2021-08-17 17:07:42'),
(22963, 1006, 22229, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:35', '2021-09-01 15:33:35'),
(22964, 11056, 22229, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:48', '2021-09-22 12:05:48'),
(22965, 11056, 22229, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:08:06', '2021-09-29 17:08:06'),
(22966, 11056, 22229, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:25:57', '2021-10-12 14:25:57'),
(22967, 11056, 22229, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:52:25', '2021-10-20 12:52:25'),
(22968, 11056, 22229, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:29:51', '2021-11-10 17:29:51'),
(22969, 11056, 22229, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:37:40', '2021-11-19 17:37:40'),
(22970, 11056, 22229, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:47:59', '2021-12-01 12:47:59'),
(22971, 11056, 22229, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:36', '2021-12-16 16:39:36'),
(22972, 11056, 22229, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:19', '2021-12-23 15:35:19'),
(22973, 19067, 22229, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:52', '2022-01-10 18:04:52'),
(22974, 19067, 22229, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:19:39', '2022-01-26 17:19:39'),
(22975, 19067, 22229, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:40', '2022-02-11 14:54:40'),
(22976, 19067, 22229, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:45', '2022-02-21 17:32:45'),
(22977, 19067, 22229, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:44', '2022-03-15 17:47:44'),
(22978, 22077, 22229, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:46:53', '2022-04-22 14:46:53'),
(22979, 3046, 22230, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:35', '2021-03-16 14:31:35'),
(22980, 3040, 22230, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:57', '2021-04-07 13:51:57'),
(22981, 9057, 22230, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:00', '2021-05-26 15:01:00'),
(22982, 1006, 22230, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:44', '2021-06-15 17:08:44'),
(22983, 1006, 22230, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:28', '2021-07-20 10:30:28'),
(22984, 1006, 22230, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:07:48', '2021-08-17 17:07:48'),
(22985, 1006, 22230, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:38', '2021-09-01 15:33:38'),
(22986, 11056, 22230, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:41', '2021-09-22 12:05:41'),
(22987, 11056, 22230, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:08:00', '2021-09-29 17:08:00'),
(22988, 11056, 22230, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:26:10', '2021-10-12 14:26:10'),
(22989, 11056, 22230, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:52:33', '2021-10-20 12:52:33'),
(22990, 11056, 22230, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-11 09:13:49', '2021-11-11 09:13:49'),
(22991, 11056, 22230, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:37:48', '2021-11-19 17:37:48'),
(22992, 11056, 22230, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:04', '2021-12-01 12:48:04');
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
(22993, 11056, 22230, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:43', '2021-12-16 16:39:43'),
(22994, 11056, 22230, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:13', '2021-12-23 15:35:13'),
(22995, 19067, 22230, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:46', '2022-01-10 18:04:46'),
(22996, 19067, 22230, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:18:43', '2022-01-26 17:18:43'),
(22997, 19067, 22230, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:35', '2022-02-11 14:54:35'),
(22998, 19067, 22230, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:39', '2022-02-21 17:32:39'),
(22999, 19067, 22230, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:39', '2022-03-15 17:47:39'),
(23000, 22077, 22230, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:46:36', '2022-04-22 14:46:36'),
(23001, 3046, 22231, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:37', '2021-03-16 14:31:37'),
(23002, 3040, 22231, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:24', '2021-04-07 13:52:24'),
(23003, 9057, 22231, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:07', '2021-05-26 15:01:07'),
(23004, 1006, 22231, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:47', '2021-06-15 17:08:47'),
(23005, 1006, 22231, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:41', '2021-07-20 10:30:41'),
(23006, 1006, 22231, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:07:54', '2021-08-17 17:07:54'),
(23007, 1006, 22231, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:46', '2021-09-01 15:33:46'),
(23008, 11056, 22231, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:36', '2021-09-22 12:05:36'),
(23009, 11056, 22231, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:53', '2021-09-29 17:07:53'),
(23010, 11056, 22231, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:26:16', '2021-10-12 14:26:16'),
(23011, 11056, 22231, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:57:04', '2021-10-20 12:57:04'),
(23012, 11056, 22231, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:29:57', '2021-11-10 17:29:57'),
(23013, 11056, 22231, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:37:56', '2021-11-19 17:37:56'),
(23014, 11056, 22231, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:37:56', '2021-11-19 17:37:56'),
(23015, 11056, 22231, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:10', '2021-12-01 12:48:10'),
(23016, 11056, 22231, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:48', '2021-12-16 16:39:48'),
(23017, 11056, 22231, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:08', '2021-12-23 15:35:08'),
(23018, 19067, 22231, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:40', '2022-01-10 18:04:40'),
(23019, 19067, 22231, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:18:29', '2022-01-26 17:18:29'),
(23020, 19067, 22231, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:30', '2022-02-11 14:54:30'),
(23021, 19067, 22231, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:34', '2022-02-21 17:32:34'),
(23022, 19067, 22231, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:27', '2022-03-15 17:47:27'),
(23023, 22077, 22231, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:46:20', '2022-04-22 14:46:20'),
(23024, 3046, 22232, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:39', '2021-03-16 14:31:39'),
(23025, 3040, 22232, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:52:44', '2021-04-07 13:52:44'),
(23026, 9057, 22232, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:14', '2021-05-26 15:01:14'),
(23027, 1006, 22232, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:49', '2021-06-15 17:08:49'),
(23028, 1006, 22232, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:55', '2021-07-20 10:30:55'),
(23029, 1006, 22232, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:07:59', '2021-08-17 17:07:59'),
(23030, 1006, 22232, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:50', '2021-09-01 15:33:50'),
(23031, 11056, 22232, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:28', '2021-09-22 12:05:28'),
(23032, 11056, 22232, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:45', '2021-09-29 17:07:45'),
(23033, 11056, 22232, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:26:25', '2021-10-12 14:26:25'),
(23034, 11056, 22232, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:58', '2021-10-20 12:56:58'),
(23035, 11056, 22232, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:03', '2021-11-10 17:30:03'),
(23036, 11056, 22232, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:02', '2021-11-19 17:38:02'),
(23037, 11056, 22232, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:17', '2021-12-01 12:48:17'),
(23038, 11056, 22232, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:39:55', '2021-12-16 16:39:55'),
(23039, 11056, 22232, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:22', '2021-12-16 16:40:22'),
(23040, 11056, 22232, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:35:01', '2021-12-23 15:35:01'),
(23041, 19067, 22232, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:35', '2022-01-10 18:04:35'),
(23042, 19067, 22232, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:18:23', '2022-01-26 17:18:23'),
(23043, 19067, 22232, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:25', '2022-02-11 14:54:25'),
(23044, 19067, 22232, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:29', '2022-02-21 17:32:29'),
(23045, 19067, 22232, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:20', '2022-03-15 17:47:20'),
(23046, 22077, 22232, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:46:09', '2022-04-22 14:46:09'),
(23047, 3046, 22233, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:41', '2021-03-16 14:31:41'),
(23048, 3040, 22233, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:02', '2021-04-07 13:53:02'),
(23049, 9057, 22233, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:21', '2021-05-26 15:01:21'),
(23050, 1006, 22233, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:54', '2021-06-15 17:08:54'),
(23051, 1006, 22233, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:31:51', '2021-07-20 10:31:51'),
(23052, 1006, 22233, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:17', '2021-08-17 17:08:17'),
(23053, 1006, 22233, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:53', '2021-09-01 15:33:53'),
(23054, 11056, 22233, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:22', '2021-09-22 12:05:22'),
(23055, 11056, 22233, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:40', '2021-09-29 17:07:40'),
(23056, 11056, 22233, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:26:59', '2021-10-12 14:26:59'),
(23057, 11056, 22233, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:52', '2021-10-20 12:56:52'),
(23058, 11056, 22233, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:09', '2021-11-10 17:30:09'),
(23059, 11056, 22233, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:08', '2021-11-19 17:38:08'),
(23060, 11056, 22233, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:24', '2021-12-01 12:48:24'),
(23061, 11056, 22233, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:28', '2021-12-16 16:40:28'),
(23062, 11056, 22233, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:34:55', '2021-12-23 15:34:55'),
(23063, 19067, 22233, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:29', '2022-01-10 18:04:29'),
(23064, 19067, 22233, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:18:16', '2022-01-26 17:18:16'),
(23065, 19067, 22233, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:15', '2022-02-11 14:54:15'),
(23066, 19067, 22233, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:22', '2022-02-21 17:32:22'),
(23067, 19067, 22233, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:14', '2022-03-15 17:47:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(23068, 22077, 22233, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:45:59', '2022-04-22 14:45:59'),
(23069, 3046, 22234, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:43', '2021-03-16 14:31:43'),
(23070, 3040, 22234, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:19', '2021-04-07 13:53:19'),
(23071, 9057, 22234, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:28', '2021-05-26 15:01:28'),
(23072, 1006, 22234, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:57', '2021-06-15 17:08:57'),
(23073, 1006, 22234, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:05', '2021-07-20 10:32:05'),
(23074, 1006, 22234, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:25', '2021-08-17 17:08:25'),
(23075, 1006, 22234, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:33:57', '2021-09-01 15:33:57'),
(23076, 11056, 22234, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:16', '2021-09-22 12:05:16'),
(23077, 11056, 22234, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:33', '2021-09-29 17:07:33'),
(23078, 11056, 22234, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:06', '2021-10-12 14:27:06'),
(23079, 11056, 22234, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:46', '2021-10-20 12:56:46'),
(23080, 11056, 22234, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:16', '2021-11-10 17:30:16'),
(23081, 11056, 22234, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:14', '2021-11-19 17:38:14'),
(23082, 11056, 22234, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:30', '2021-12-01 12:48:30'),
(23083, 11056, 22234, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:34', '2021-12-16 16:40:34'),
(23084, 11056, 22234, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:34:50', '2021-12-23 15:34:50'),
(23085, 19067, 22234, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:22', '2022-01-10 18:04:22'),
(23086, 19067, 22234, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:18:11', '2022-01-26 17:18:11'),
(23087, 19067, 22234, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:09', '2022-02-11 14:54:09'),
(23088, 19067, 22234, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:16', '2022-02-21 17:32:16'),
(23089, 19067, 22234, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:47:08', '2022-03-15 17:47:08'),
(23090, 22077, 22234, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:45:50', '2022-04-22 14:45:50'),
(23091, 3046, 22235, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:45', '2021-03-16 14:31:45'),
(23092, 3040, 22235, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:37', '2021-04-07 13:53:37'),
(23093, 9057, 22235, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:36', '2021-05-26 15:01:36'),
(23094, 1006, 22235, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:59', '2021-06-15 17:08:59'),
(23095, 1006, 22235, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:20', '2021-07-20 10:32:20'),
(23096, 1006, 22235, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:31', '2021-08-17 17:08:31'),
(23097, 1006, 22235, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:34:01', '2021-09-01 15:34:01'),
(23098, 11056, 22235, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:10', '2021-09-22 12:05:10'),
(23099, 11056, 22235, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:27', '2021-09-29 17:07:27'),
(23100, 11056, 22235, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:12', '2021-10-12 14:27:12'),
(23101, 11056, 22235, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:41', '2021-10-20 12:56:41'),
(23102, 11056, 22235, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:22', '2021-11-10 17:30:22'),
(23103, 11056, 22235, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:20', '2021-11-19 17:38:20'),
(23104, 11056, 22235, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:37', '2021-12-01 12:48:37'),
(23105, 11056, 22235, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:39', '2021-12-16 16:40:39'),
(23106, 11056, 22235, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:34:45', '2021-12-23 15:34:45'),
(23107, 19067, 22235, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:17', '2022-01-10 18:04:17'),
(23108, 19067, 22235, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:17:46', '2022-01-26 17:17:46'),
(23109, 19067, 22235, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:54:04', '2022-02-11 14:54:04'),
(23110, 19067, 22235, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:10', '2022-02-21 17:32:10'),
(23111, 19067, 22235, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:46:35', '2022-03-15 17:46:35'),
(23112, 22077, 22235, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:45:40', '2022-04-22 14:45:40'),
(23113, 3046, 22236, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:48', '2021-03-16 14:31:48'),
(23114, 3040, 22236, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:53:55', '2021-04-07 13:53:55'),
(23115, 9057, 22236, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:43', '2021-05-26 15:01:43'),
(23116, 1006, 22236, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:09:03', '2021-06-15 17:09:03'),
(23117, 1006, 22236, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:33', '2021-07-20 10:32:33'),
(23118, 1006, 22236, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:39', '2021-08-17 17:08:39'),
(23119, 1006, 22236, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:48', '2021-08-17 17:08:48'),
(23120, 1006, 22236, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:34:04', '2021-09-01 15:34:04'),
(23121, 11056, 22236, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:05:04', '2021-09-22 12:05:04'),
(23122, 11056, 22236, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:22', '2021-09-29 17:07:22'),
(23123, 11056, 22236, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:18', '2021-10-12 14:27:18'),
(23124, 11056, 22236, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:35', '2021-10-12 14:27:35'),
(23125, 11056, 22236, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:52', '2021-10-12 14:27:52'),
(23126, 11056, 22236, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:56:34', '2021-10-20 12:56:34'),
(23127, 11056, 22236, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:28', '2021-11-10 17:30:28'),
(23128, 11056, 22236, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:26', '2021-11-19 17:38:26'),
(23129, 11056, 22236, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:42', '2021-12-01 12:48:42'),
(23130, 11056, 22236, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:45', '2021-12-16 16:40:45'),
(23131, 11056, 22236, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:34:39', '2021-12-23 15:34:39'),
(23132, 19067, 22236, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:10', '2022-01-10 18:04:10'),
(23133, 19067, 22236, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:17:26', '2022-01-26 17:17:26'),
(23134, 19067, 22236, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:53:57', '2022-02-11 14:53:57'),
(23135, 19067, 22236, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:32:05', '2022-02-21 17:32:05'),
(23136, 19067, 22236, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:46:25', '2022-03-15 17:46:25'),
(23137, 22077, 22236, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:45:31', '2022-04-22 14:45:31'),
(23138, 3046, 22237, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:31:50', '2021-03-16 14:31:50'),
(23139, 3040, 22237, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:54:12', '2021-04-07 13:54:12');
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
(23140, 9057, 22237, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:01:51', '2021-05-26 15:01:51'),
(23141, 1006, 22237, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:09:06', '2021-06-15 17:09:06'),
(23142, 1006, 22237, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:32:48', '2021-07-20 10:32:48'),
(23143, 1006, 22237, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:08:56', '2021-08-17 17:08:56'),
(23144, 1006, 22237, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:34:08', '2021-09-01 15:34:08'),
(23145, 11056, 22237, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:04:56', '2021-09-22 12:04:56'),
(23146, 11056, 22237, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:07:15', '2021-09-29 17:07:15'),
(23147, 11056, 22237, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:27:25', '2021-10-12 14:27:25'),
(23148, 11056, 22237, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:57:57', '2021-10-20 12:57:57'),
(23149, 11056, 22237, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:30:34', '2021-11-10 17:30:34'),
(23150, 11056, 22237, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:38:31', '2021-11-19 17:38:31'),
(23151, 11056, 22237, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:48:50', '2021-12-01 12:48:50'),
(23152, 11056, 22237, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:40:52', '2021-12-16 16:40:52'),
(23153, 11056, 22237, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   The NPI and Tax ID is the same as the main and billing location for all locations. Please see below.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382', NULL, NULL, '2021-12-23 15:34:33', '2021-12-23 15:34:33'),
(23154, 19067, 22237, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Greetings!   Any updates on the previously mentioned request?   Kindly respond promptly.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-10 18:04:04', '2022-01-10 18:04:04'),
(23155, 19067, 22237, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello Zuzy!  This is my Second Reminder on the below mentioned request.  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:17:21', '2022-01-26 17:17:21'),
(23156, 19067, 22237, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  I haven\'t heard from you and it\'s been a while now. Could you please look into my request?    Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:53:52', '2022-02-11 14:53:52'),
(23157, 19067, 22237, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||   Hello!  Kindly respond to my request at your earliest convenience because it\'s been a long time since you responded.   Regards, Hammad Ahmed. ', NULL, NULL, '2022-02-21 17:31:58', '2022-02-21 17:31:58'),
(23158, 19067, 22237, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Email received from: Zujey.Ashbaugh@superiorhealthplan.com  Subject: Re: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||    Hello,     Here is the packet and welcome letter per your request.     Thank you,    SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com', NULL, NULL, '2022-03-15 17:46:19', '2022-03-15 17:46:19'),
(23159, 22077, 22237, NULL, '2022-04-29 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Subject: Enrollment Status Query || Statcare Minor Emergency Clinic || Superior Health ||  Hi,  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E Caesar Kingsville, TX 78363 Secondary Location	6646 S. Staples St. #122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382   Here is the information you asked for.  I am looking forward to your kind response.  Thanks & Regards.', NULL, NULL, '2022-04-22 14:45:23', '2022-04-22 14:45:23'),
(23160, 3046, 22238, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:05', '2021-03-16 14:34:05'),
(23161, 3040, 22238, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:57:47', '2021-04-08 14:57:47'),
(23162, 9057, 22238, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:01', '2021-05-26 15:49:01'),
(23163, 3040, 22238, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:46', '2021-06-15 17:00:46'),
(23164, 1006, 22238, NULL, '2021-06-30 00:00:00.000', 'In Process', 'Sent f/u and address addition email @ ccampos@trpnppo.com:  Sub: Group enrollment & address addition query   \"Hello Carlos,  I wanted to verify what the effective date of the following group is, also we wanted to add the following location under the group and the following provider as well:   Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Provider Name: Traci Mason NPI# 1497127831  Additional Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please let me know if you have any questions.  Thank you!\"', NULL, NULL, '2021-06-23 10:53:15', '2021-06-23 10:53:15'),
(23165, 1006, 22238, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ ccampos@trpnppo.com & providerrelations@trpnppo.com:   Sub: Group enrollment & address addition query  \"Hello Carlos,   I hope you\'re doing well, I wanted to check in on the status of this request. I would appreciate it if you could please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-08 17:25:03', '2021-07-08 17:25:03'),
(23166, 1006, 22238, NULL, '2021-07-20 00:00:00.000', 'In Process', 'We received the following update from ccampos@trpnppo.com:  Sub: RE: Group enrollment & address addition query  \"Hello Brad,   This group is Active, effective date 04/26/2016,   Provider Traci Mason is Active, effective date 01/01/2021,   Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com www.trpnppo.com\"  Replied with:   \"Hello Carlos,   I appreciate the update but the address mentioned is still not showing up under the provider or group on the TRPN provider directory, could you let me know when that will be updated?  Thank you!\"', NULL, NULL, '2021-07-13 08:37:00', '2021-07-13 08:37:00'),
(23167, 1006, 22238, NULL, '2021-08-31 00:00:00.000', 'Approved', 'All providers have been added to the group address. Approving task.   Eff: 04/26/2016', NULL, NULL, '2021-08-24 10:59:05', '2021-08-24 10:59:05'),
(23168, 3046, 22239, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:11', '2021-03-16 14:34:11'),
(23169, 3040, 22239, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:21', '2021-04-08 14:58:21'),
(23170, 3040, 22239, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:19', '2021-04-09 12:36:19'),
(23171, 9057, 22239, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:11', '2021-05-26 15:49:11'),
(23172, 3040, 22239, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:44', '2021-06-15 17:00:44'),
(23173, 1006, 22239, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:35:12', '2021-06-23 11:35:12'),
(23174, 3046, 22240, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:14', '2021-03-16 14:34:14'),
(23175, 3040, 22240, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:58:54', '2021-04-08 14:58:54'),
(23176, 3040, 22240, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:23', '2021-04-09 12:36:23'),
(23177, 9057, 22240, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:19', '2021-05-26 15:49:19'),
(23178, 3040, 22240, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:42', '2021-06-15 17:00:42'),
(23179, 1006, 22240, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:35:31', '2021-06-23 11:35:31'),
(23180, 3046, 22241, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:15', '2021-03-16 14:34:15'),
(23181, 3040, 22241, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 14:59:58', '2021-04-08 14:59:58'),
(23182, 3040, 22241, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:26', '2021-04-09 12:36:26'),
(23183, 9057, 22241, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:29', '2021-05-26 15:49:29'),
(23184, 3040, 22241, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:40', '2021-06-15 17:00:40'),
(23185, 1006, 22241, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:35:52', '2021-06-23 11:35:52'),
(23186, 3046, 22242, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:21', '2021-03-16 14:34:21'),
(23187, 3040, 22242, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:34:08', '2021-04-08 15:34:08'),
(23188, 3040, 22242, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:29', '2021-04-09 12:36:29'),
(23189, 9057, 22242, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:38', '2021-05-26 15:49:38'),
(23190, 3040, 22242, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:38', '2021-06-15 17:00:38'),
(23191, 1006, 22242, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:36:12', '2021-06-23 11:36:12'),
(23192, 3046, 22243, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:22', '2021-03-16 14:34:22'),
(23193, 3040, 22243, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:02', '2021-04-08 15:35:02'),
(23194, 3040, 22243, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:36:33', '2021-04-09 12:36:33');
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
(23195, 9057, 22243, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:48', '2021-05-26 15:49:48'),
(23196, 3040, 22243, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:37', '2021-06-15 17:00:37'),
(23197, 1006, 22243, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:36:33', '2021-06-23 11:36:33'),
(23198, 3046, 22244, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:24', '2021-03-16 14:34:24'),
(23199, 3040, 22244, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:35:31', '2021-04-08 15:35:31'),
(23200, 3040, 22244, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:07', '2021-04-09 12:50:07'),
(23201, 9057, 22244, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:49:56', '2021-05-26 15:49:56'),
(23202, 3040, 22244, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:35', '2021-06-15 17:00:35'),
(23203, 1006, 22244, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:36:55', '2021-06-23 11:36:55'),
(23204, 3046, 22245, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:26', '2021-03-16 14:34:26'),
(23205, 3040, 22245, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:01', '2021-04-08 15:36:01'),
(23206, 3040, 22245, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:23', '2021-04-09 12:50:23'),
(23207, 9057, 22245, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:50:06', '2021-05-26 15:50:06'),
(23208, 3040, 22245, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:34', '2021-06-15 17:00:34'),
(23209, 1006, 22245, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:37:21', '2021-06-23 11:37:21'),
(23210, 3046, 22246, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:28', '2021-03-16 14:34:28'),
(23211, 3040, 22246, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:36:29', '2021-04-08 15:36:29'),
(23212, 3040, 22246, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:38', '2021-04-09 12:50:38'),
(23213, 9057, 22246, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:50:22', '2021-05-26 15:50:22'),
(23214, 3040, 22246, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:30', '2021-06-15 17:00:30'),
(23215, 1006, 22246, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:37:42', '2021-06-23 11:37:42'),
(23216, 3046, 22247, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:30', '2021-03-16 14:34:30'),
(23217, 3040, 22247, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:37:01', '2021-04-08 15:37:01'),
(23218, 3040, 22247, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:50:55', '2021-04-09 12:50:55'),
(23219, 9057, 22247, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:50:33', '2021-05-26 15:50:33'),
(23220, 3040, 22247, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:28', '2021-06-15 17:00:28'),
(23221, 1006, 22247, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:38:01', '2021-06-23 11:38:01'),
(23222, 3046, 22248, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:34:33', '2021-03-16 14:34:33'),
(23223, 3040, 22248, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: providerrelations@trpnppo.com, trpndataentry@trpnppo.com  Subject: Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 15:37:29', '2021-04-08 15:37:29'),
(23224, 3040, 22248, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Email sent to: providerrelations@trpnppo.com  Subject:  Enroll Group & Providers || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. Please find the attached provider update information form for below mentioned providers that was requested in your previous email.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-09 12:51:12', '2021-04-09 12:51:12'),
(23225, 9057, 22248, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to: trpndataentry@trpnppo.com Sub: Enrollment request status request - RHC -Three Rivers Provider Network - TRPN  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider Details Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Kindly Let us know the current status for the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 15:50:44', '2021-05-26 15:50:44'),
(23226, 3040, 22248, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Enrollment Status || Statcare Minor Emergency Clinic || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in TRPN under the below locations.   Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-06-15 17:00:26', '2021-06-15 17:00:26'),
(23227, 1006, 22248, NULL, '2021-06-30 00:00:00.000', 'Approved', 'The provider is enrolled with TRPN, Approval and location confirmation are attached for reference.   Eff: 01/01/2021 ', NULL, NULL, '2021-06-23 11:38:23', '2021-06-23 11:38:23'),
(23228, 3046, 22249, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:12', '2021-03-16 14:39:12'),
(23229, 3040, 22249, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 08:52:51', '2021-04-08 08:52:51'),
(23230, 1006, 22249, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group has been added to the mentioned address, approval and location confirmation is attached for reference. Eff: 12/22/2018', NULL, NULL, '2021-05-11 10:05:31', '2021-05-11 10:05:31'),
(23231, 3046, 22250, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:14', '2021-03-16 14:39:14'),
(23232, 3040, 22250, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider Participating with UHC.  ', NULL, NULL, '2021-04-08 08:56:34', '2021-04-08 08:56:34'),
(23233, 3046, 22251, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:15', '2021-03-16 14:39:15'),
(23234, 3040, 22251, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC. ', NULL, NULL, '2021-04-08 09:01:28', '2021-04-08 09:01:28'),
(23235, 3046, 22252, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:16', '2021-03-16 14:39:16'),
(23236, 3040, 22252, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider participating with UHC.', NULL, NULL, '2021-04-08 09:05:59', '2021-04-08 09:05:59'),
(23237, 3046, 22253, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:18', '2021-03-16 14:39:18'),
(23238, 3040, 22253, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider Participating with UHC. ', NULL, NULL, '2021-04-08 09:30:57', '2021-04-08 09:30:57'),
(23239, 1006, 22253, NULL, '2021-09-06 00:00:00.000', 'Revalidation', 'We received the following email from donotreplyemail@aperturecvo.com:  Sub; Important Credentialing Information Requested: MASON, TRACI SMITH - 8C3PT  \"Aperture Credentialing, LLC, a national credentials verification organization, has been contracted to handle primary source verification of your credentials.  Documentation needed to complete your credentialing application is missing, incomplete, or expired.  In order to continue the credentialing process with the Health Plan(s) requesting information, you will need to provide the requested information within three (3) business days from the date of this notice so that the processing of your application can be completed.  Health Plan(s) Requesting Information: United HealthCare of Houston  Credentials Request for: MASON, TRACI SMITH  Attention: Traci Mason Credentialing Contact  Information Requested: Please provide who admits on your behalf, or the name of the covering colleague, or hospitalist group name?  How to Respond: Fax:  Click on the Aperture Supporting Documentation website link below to download your custom fax coversheet and fax number to transmit information requested via fax. Online:  Click on the Aperture Supporting Documentation website link below to download specific forms, attach documentation, or provide a quick response for information requested.  NOTE: This email was sent from a notification-only email address that cannot accept incoming email.  Please do not reply to this message. The website link is custom to the provider and health plan specific to the Credentialing Information Request contained in this email.  Please do not submit other providers not listed in this email using this link. Please disregard this notice if you have already submitted your application or information requested. If you are using CAQH to upload supporting documentation, please allow up to two (2) business days for CAQH processing.  Once the documents are processed by CAQH, Aperture will be able to download that information. Aperture Supporting Documentation website: https://outreach.aperturecvo.com/445a83f7-ea0e-4a82-b59c-1b46e53d50b0\"  Replied with request information as Rolando Perez is her supervising physican. ', NULL, NULL, '2021-08-30 14:58:44', '2021-08-30 14:58:44'),
(23240, 11056, 22253, NULL, '2021-09-28 00:00:00.000', 'Revalidation', '	 Email sent to : networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC  Good evening!  Hope all is well with you. Please provide me with the recredentialing status for the below mentioned provider under the facility TIN. And also confirm if all of the locations are listed below that provider or not?  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: Mason, Traci Smith Provider NPI# 1497127831  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-21 17:12:19', '2021-09-21 17:12:19'),
(23241, 11056, 22253, NULL, '2021-10-01 00:00:00.000', 'Revalidation', 'Secure Message from david.c.cliff@optum.com', NULL, NULL, '2021-09-24 13:53:45', '2021-09-24 13:53:45'),
(23242, 11056, 22253, NULL, '2021-10-19 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good Afternoon,  The provider is currently in a recredentialing process that is due 11/2021 (the CAQH application has been accessed and the recredentialing will complete before the end of 11/2021).  The only service locations loaded for this provider are  3817 S PADRE ISLAND DR CORPUS CHRISTI, TX 78415-2913 and 4042 RIVER HILL DR CORPUS CHRISTI, TX 78410-5606   David Cliff UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-10-12 10:59:40', '2021-10-12 10:59:40'),
(23243, 11056, 22253, NULL, '2021-10-25 00:00:00.000', 'Revalidation', 'Email sent to : networkhelp@uhc.com  Sub : Secure Message from david.c.cliff@optum.com  Good afternoon!  Hope this email finds you well. What about the other 2 mentioned below 1. Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 2. Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413', NULL, NULL, '2021-10-18 12:54:22', '2021-10-18 12:54:22'),
(23244, 11056, 22253, NULL, '2021-11-01 00:00:00.000', 'Revalidation', 'Email received from : networkhelp@uhc.com  Sub : RE: Secure Message from david.c.cliff@optum.com  The 500 E CAESAR  KINGSVILLE , TX 78363 and 6646 S. Staples St. # 122 Corpus Christi , TX 78413 are currently not loaded as service locations for this provider.  A request to add these locations would need to be submitted to our demographics group for processing   Request has been submitted', NULL, NULL, '2021-10-25 13:13:56', '2021-10-25 13:13:56'),
(23245, 11056, 22253, NULL, '2021-11-18 00:00:00.000', 'Revalidation', 'Email sent to: hpdemo@uhc.com,  networkhelp@uhc.com  Sub : Status Update of recredentialing - Traci Mason - UHC - Statcare Minor Emergency Clinic   Good afternoon!  Hope you are having a great day. Has the re-credentialing been completed of the provider, Traci Mason? Have all the below mention locations been listed under the provider?  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2101 FM 2165, Rockport, TX 78382 Provider Name	NPI Traci Mason	1497127831  Please respond to my query at your earliest convenience.  Thank You! Have a wonderful day!', NULL, NULL, '2021-11-11 13:58:19', '2021-11-11 13:58:19'),
(23246, 11056, 22253, NULL, '2021-11-23 00:00:00.000', 'Revalidated', 'Email received from: networkhelp@uhc.com  Sub : Secure Message from cameron_l_pickett@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.       Sincerely,       *--SecureDelivery--*    All locations are added. Please see the roster.', NULL, NULL, '2021-11-16 14:39:42', '2021-11-16 14:39:42'),
(23247, 3046, 22254, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:19', '2021-03-16 14:39:19'),
(23248, 3040, 22254, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Additional Location || Statcare Minor Emergency Clinic || Providers || UMR ||  Greetings,  Hope you are doing well. I wanted to add the providers in the UHC for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 3: Provider Name: Capupus, Mari Katrina  Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415       Provider 4: Provider Name: Gonzalez, Mary C  Provider NPI# 1952713083 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415          Provider 5: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 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: 3817 South Padre Island Drive Corpus Christi , TX 78415    Provider 7: Provider Name: Svatek, Maegan  Provider NPI#  1639670250 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-08 09:38:10', '2021-04-08 09:38:10'),
(23249, 3040, 22254, NULL, '2021-04-16 00:00:00.000', 'Approved', 'Email sent to: networkhelp@uhc.com  Subject: Secure Message from susan_k_isaacson@uhc.com  I have attached the roster you requested.         ', NULL, NULL, '2021-04-09 16:19:56', '2021-04-09 16:19:56'),
(23250, 3046, 22255, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:21', '2021-03-16 14:39:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(23251, 3040, 22255, NULL, '2021-04-15 00:00:00.000', 'Initiated', 'Email sent to: networkhelp@uhc.com  Subject: Request for Roster || Statcare Minor Emergency Clinic || Group & Providers || UHC ||  Greetings,  Hope you are doing well. Can you please send me the roster for the below mentioned group and providers for our group Statcare Minor Emergency Clinic.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-04-08 09:43:38', '2021-04-08 09:43:38'),
(23252, 3040, 22255, NULL, '2021-04-16 00:00:00.000', 'Approved', 'Provider Participating with UHC.', NULL, NULL, '2021-04-09 16:31:40', '2021-04-09 16:31:40'),
(23253, 3046, 22256, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 14:39:23', '2021-03-16 14:39:23'),
(23254, 3040, 22256, NULL, '2021-04-15 00:00:00.000', 'Approved', 'Provider enrolled with UHC. ', NULL, NULL, '2021-04-08 09:57:03', '2021-04-08 09:57:03'),
(23255, 3040, 22268, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:39:54', '2021-03-16 15:39:54'),
(23256, 3040, 22268, NULL, '2021-04-09 00:00:00.000', 'Approved', 'I had a word with (Maria S) Aetna representative and she said the practice is showing in-network and allow us 30 days to show up on provider directory.   Ref: 6010995552 ', NULL, NULL, '2021-04-02 08:44:34', '2021-04-02 08:44:34'),
(23257, 3040, 22269, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:40:40', '2021-03-16 15:40:40'),
(23258, 3040, 22269, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Group will be enrolled with providers. ', NULL, NULL, '2021-04-02 08:45:41', '2021-04-02 08:45:41'),
(23259, 3040, 22269, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email rcvd from: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Dada, Oladipo & Dada, Atinuke || Ladot Healthcare LLC || Ambetter ||  Good afternoon,  I am able to locate the following information per the status request below for the providers:  Provider Name: Dada, Oladipo  Provider NPI# 1760700223: The providers credentialing is complete, the effective date will be 06/01/2021 ,the re-credential date will be 04/30/2024.   Provider Name: Dada, Atinuke  Provider NPI# 1154782720 : I currently show the file is in progress and has not been completed at this time, the cred spec will contact you directly if there is any missing/incomplete information.  ', NULL, NULL, '2021-05-25 13:48:53', '2021-05-25 13:48:53'),
(23260, 1006, 22269, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Credentialing Credentialing@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 11:53:58', '2021-06-11 11:53:58'),
(23261, 1006, 22269, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Sub : Enroll Group & Providers || Ladot Healthcare LLC || Christus Spohn ||  Greetings,  Hope you are doing well. Kindly respond to me as soon as possible. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group Ladot Healthcare LLC.  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City, TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.  Thank you!', NULL, NULL, '2021-06-30 13:19:50', '2021-06-30 13:19:50'),
(23262, 1006, 22269, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub : Enrollment Status - LHC - Ambetter  Hello,  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following providers with Ambetter, their information is as follows:  Practice:  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue, League City, TX 77573  Provider : Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Please get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-06-30 14:27:23', '2021-06-30 14:27:23'),
(23263, 1006, 22269, NULL, '2021-07-09 00:00:00.000', 'Approved', 'We received the following approval confirmation from AM Houston AM.Houston@superiorhealthplan.com:  Sub: Enrollment Status - LHC - Ambetter  \"Good morning Ahmed  Happy Friday  Here is the information you requested for the following Providers:  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider Name: Dada, Atinuke Provider NPI# 1154782720   Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs cid:image002.jpg@01D0C3DA.F54AEF00 711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3\"  Approval confirmation is attached for reference.', NULL, NULL, '2021-07-02 14:18:48', '2021-07-02 14:18:48'),
(23264, 3046, 22270, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:40:56', '2021-03-16 15:40:56'),
(23265, 1006, 22270, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:23', '2021-03-25 15:30:23'),
(23266, 1006, 22270, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:00', '2021-06-03 14:50:00'),
(23267, 1006, 22270, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:40:12', '2021-06-21 14:40:12'),
(23268, 3046, 22271, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:40:58', '2021-03-16 15:40:58'),
(23269, 1006, 22271, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:29:42', '2021-03-25 15:29:42'),
(23270, 1006, 22271, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:03', '2021-06-03 14:50:03'),
(23271, 1006, 22271, NULL, '2021-06-28 00:00:00.000', 'In Process', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:41:12', '2021-06-21 14:41:12'),
(23272, 1006, 22271, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:41:29', '2021-06-21 14:41:29'),
(23273, 3046, 22272, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:00', '2021-03-16 15:41:00'),
(23274, 1006, 22272, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:29:52', '2021-03-25 15:29:52'),
(23275, 1006, 22272, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:07', '2021-06-03 14:50:07'),
(23276, 1006, 22272, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:41:51', '2021-06-21 14:41:51'),
(23277, 3046, 22273, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:02', '2021-03-16 15:41:02'),
(23278, 1006, 22273, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:29:56', '2021-03-25 15:29:56'),
(23279, 1006, 22273, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:11', '2021-06-03 14:50:11'),
(23280, 1006, 22273, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:42:02', '2021-06-21 14:42:02'),
(23281, 3046, 22274, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:04', '2021-03-16 15:41:04'),
(23282, 1006, 22274, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:00', '2021-03-25 15:30:00'),
(23283, 1006, 22274, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:14', '2021-06-03 14:50:14'),
(23284, 1006, 22274, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been update for the group and since this is an ancillary contract all the providers have the update location as well.   Eff: 03/02/2017  Approval confirmation is attached in main group task for reference. ', NULL, NULL, '2021-06-21 14:42:29', '2021-06-21 14:42:29'),
(23285, 3046, 22275, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:06', '2021-03-16 15:41:06'),
(23286, 1006, 22275, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:03', '2021-03-25 15:30:03'),
(23287, 1006, 22275, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:17', '2021-06-03 14:50:17'),
(23288, 1006, 22275, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been updated for the group and since this is an ancillary contract all the providers have the updated location as well.   Eff: 03/02/2017  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-06-21 14:43:03', '2021-06-21 14:43:03'),
(23289, 3046, 22276, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:08', '2021-03-16 15:41:08'),
(23290, 1006, 22276, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:07', '2021-03-25 15:30:07'),
(23291, 1006, 22276, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:22', '2021-06-03 14:50:22'),
(23292, 1006, 22276, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been updated for the group and since this is an ancillary contract all the providers have the updated location as well.   Eff: 03/02/2017  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-06-21 14:43:24', '2021-06-21 14:43:24'),
(23293, 3046, 22277, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:09', '2021-03-16 15:41:09'),
(23294, 1006, 22277, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:10', '2021-03-25 15:30:10'),
(23295, 1006, 22277, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:50:25', '2021-06-03 14:50:25'),
(23296, 1006, 22277, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been updated for the group and since this is an ancillary contract all the providers have the updated location as well.   Eff: 03/02/2017  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-06-21 14:43:49', '2021-06-21 14:43:49'),
(23297, 3046, 22278, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:12', '2021-03-16 15:41:12'),
(23298, 1006, 22278, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:14', '2021-03-25 15:30:14'),
(23299, 1006, 22278, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:49:45', '2021-06-03 14:49:45'),
(23300, 1006, 22278, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been updated for the group and since this is an ancillary contract all the providers have the updated location as well.   Eff: 03/02/2017  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-06-21 14:44:01', '2021-06-21 14:44:01'),
(23301, 3046, 22279, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:15', '2021-03-16 15:41:15'),
(23302, 1006, 22279, NULL, '2021-04-01 00:00:00.000', 'Initiated', 'The request has been submitted and is in-process for location addition to our urgent care contract, need to allow time for it to process. ', NULL, NULL, '2021-03-25 15:30:18', '2021-03-25 15:30:18'),
(23303, 1006, 22279, NULL, '2021-06-10 00:00:00.000', 'In Process', 'As per my discussion with Aetna rep May, the request has been completed as of Feb 15, 2021.  We are currently waiting on the directory to be updated with this information.   Ref# 6022699351', NULL, NULL, '2021-06-03 14:49:40', '2021-06-03 14:49:40'),
(23304, 1006, 22279, NULL, '2021-06-28 00:00:00.000', 'Approved', 'The location has been updated for the group and since this is an ancillary contract all the providers have the updated location as well.   Eff: 03/02/2017  Approval confirmation is attached in the main group task for reference. ', NULL, NULL, '2021-06-21 14:44:31', '2021-06-21 14:44:31'),
(23305, 3040, 22280, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:38', '2021-03-16 15:41:38'),
(23306, 3040, 22280, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Email sent to: vipproviders@anci-care.com  Subject:  Enroll Group & Providers || Ladot Healthcare LLC || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Anci Care under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 10:43:42', '2021-04-02 10:43:42'),
(23307, 3040, 22280, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Due to no physical location we can\'t do the ancillary contract. ', NULL, NULL, '2021-04-06 08:42:31', '2021-04-06 08:42:31'),
(23308, 3040, 22281, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:52', '2021-03-16 15:41:52'),
(23309, 3040, 22281, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Email sent to: vipproviders@anci-care.com  Subject:  Enroll Group & Providers || Ladot Healthcare LLC || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Anci Care under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 10:43:46', '2021-04-02 10:43:46'),
(23310, 3040, 22281, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Due to no physical location we can\'t do the ancillary contract. ', NULL, NULL, '2021-04-06 08:42:35', '2021-04-06 08:42:35'),
(23311, 3040, 22282, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:41:59', '2021-03-16 15:41:59'),
(23312, 3040, 22282, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Email sent to: vipproviders@anci-care.com  Subject:  Enroll Group & Providers || Ladot Healthcare LLC || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Anci Care under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 10:43:51', '2021-04-02 10:43:51'),
(23313, 3040, 22282, NULL, '2021-04-13 00:00:00.000', 'Not Eligible', 'Due to no physical location we can\'t do the ancillary contract. ', NULL, NULL, '2021-04-06 08:42:41', '2021-04-06 08:42:41'),
(23314, 3040, 22283, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:04', '2021-03-16 15:43:04'),
(23315, 3040, 22283, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-04-02 08:20:50', '2021-04-02 08:20:50'),
(23316, 3040, 22283, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-05-25 14:07:52', '2021-05-25 14:07:52'),
(23317, 1006, 22283, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment form @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - LHC - CHC  \"Hello,  Please find the attached enrollment request form for our group, please let me know if anything else is required to proceed. Thank you. \"  The enrollment form is attached for reference. ', NULL, NULL, '2021-06-14 16:27:42', '2021-06-14 16:27:42'),
(23318, 1006, 22283, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub; Enrollment Request - LHC - CHC  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name:  Ladot Healthcare LLC NPI# 1912502626 TIN# 85-2432283  Provider Name: Oladipo Dada NPI# 1760700223  Provider Name: Atinuke Dada NPI# 1154782720  Please get back to me as soon as possible.   Thank you.\"', NULL, NULL, '2021-07-02 15:06:57', '2021-07-02 15:06:57'),
(23319, 11056, 22283, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Letter received through Email : CHC.Contracting@communityhealthchoice.org  Thank you for your interest in joining Community Health Choice (Community) network of participating providers. Upon review of your information, Community determined that the Provider Network is adequate for providers of your specialty or geographic area. Community will retain your information for a period of one (1) year. If a need arises in your specialty during that time, we will contact you.  Kindly see the attachments the letter is attached .', NULL, NULL, '2021-07-13 16:56:56', '2021-07-13 16:56:56'),
(23320, 3040, 22284, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:17', '2021-03-16 15:43:17'),
(23321, 3040, 22284, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-04-02 08:21:00', '2021-04-02 08:21:00'),
(23322, 3040, 22284, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-05-25 14:07:52', '2021-05-25 14:07:52'),
(23323, 1006, 22284, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment form @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - LHC - CHC  \"Hello,  Please find the attached enrollment request form for our group, please let me know if anything else is required to proceed. Thank you. \"  The enrollment form is attached for reference. ', NULL, NULL, '2021-06-14 16:27:51', '2021-06-14 16:27:51'),
(23324, 1006, 22284, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub; Enrollment Request - LHC - CHC  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name:  Ladot Healthcare LLC NPI# 1912502626 TIN# 85-2432283  Provider Name: Oladipo Dada NPI# 1760700223  Provider Name: Atinuke Dada NPI# 1154782720  Please get back to me as soon as possible.   Thank you.\"', NULL, NULL, '2021-07-02 15:06:53', '2021-07-02 15:06:53'),
(23325, 11056, 22284, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Letter received through Email : CHC.Contracting@communityhealthchoice.org  Thank you for your interest in joining Community Health Choice (Community) network of participating providers. Upon review of your information, Community determined that the Provider Network is adequate for providers of your specialty or geographic area. Community will retain your information for a period of one (1) year. If a need arises in your specialty during that time, we will contact you.  Kindly see the attachments the letter is attached .', NULL, NULL, '2021-07-13 16:57:20', '2021-07-13 16:57:20'),
(23326, 3040, 22285, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:27', '2021-03-16 15:43:27'),
(23327, 3040, 22285, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-04-02 08:21:06', '2021-04-02 08:21:06'),
(23328, 3040, 22285, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Waiting for Medicare and Medicaid approval. ', NULL, NULL, '2021-05-25 14:07:53', '2021-05-25 14:07:53'),
(23329, 1006, 22285, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Sent enrollment form @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment Request - LHC - CHC  \"Hello,  Please find the attached enrollment request form for our group, please let me know if anything else is required to proceed. Thank you. \"  The enrollment form is attached for reference. ', NULL, NULL, '2021-06-14 16:27:47', '2021-06-14 16:27:47'),
(23330, 1006, 22285, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Sent f/u email @ CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub; Enrollment Request - LHC - CHC  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers:   Group Name:  Ladot Healthcare LLC NPI# 1912502626 TIN# 85-2432283  Provider Name: Oladipo Dada NPI# 1760700223  Provider Name: Atinuke Dada NPI# 1154782720  Please get back to me as soon as possible.   Thank you.\"', NULL, NULL, '2021-07-02 15:06:49', '2021-07-02 15:06:49'),
(23331, 11056, 22285, NULL, '2021-07-21 00:00:00.000', 'Not Eligible', 'Letter received through Email : CHC.Contracting@communityhealthchoice.org  Thank you for your interest in joining Community Health Choice (Community) network of participating providers. Upon review of your information, Community determined that the Provider Network is adequate for providers of your specialty or geographic area. Community will retain your information for a period of one (1) year. If a need arises in your specialty during that time, we will contact you.  Kindly see the attachments the letter is attached .', NULL, NULL, '2021-07-13 16:57:29', '2021-07-13 16:57:29'),
(23332, 3046, 22286, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:44', '2021-03-16 15:43:44'),
(23333, 1005, 22286, NULL, '2021-04-01 00:00:00.000', 'New/Not Initiated', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:14:46', '2021-03-25 14:14:46'),
(23334, 1005, 22286, NULL, '2021-04-01 00:00:00.000', 'Approved', NULL, NULL, NULL, '2021-03-25 14:15:09', '2021-03-25 14:15:09'),
(23335, 3046, 22287, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:45', '2021-03-16 15:43:45'),
(23336, 1005, 22287, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:15:11', '2021-03-25 14:15:11'),
(23337, 3046, 22288, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:47', '2021-03-16 15:43:47'),
(23338, 1005, 22288, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:15:14', '2021-03-25 14:15:14'),
(23339, 3046, 22289, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:48', '2021-03-16 15:43:48'),
(23340, 1005, 22289, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:15:20', '2021-03-25 14:15:20'),
(23341, 3046, 22290, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:43:58', '2021-03-16 15:43:58'),
(23342, 1005, 22290, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:15:22', '2021-03-25 14:15:22'),
(23343, 3046, 22291, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:00', '2021-03-16 15:44:00'),
(23344, 1005, 22291, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:15:26', '2021-03-25 14:15:26'),
(23345, 3046, 22292, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:03', '2021-03-16 15:44:03'),
(23346, 1005, 22292, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:17:48', '2021-03-25 14:17:48'),
(23347, 3046, 22293, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:05', '2021-03-16 15:44:05'),
(23348, 1005, 22293, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:17:59', '2021-03-25 14:17:59'),
(23349, 3046, 22294, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:07', '2021-03-16 15:44:07'),
(23350, 1005, 22294, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:18:02', '2021-03-25 14:18:02'),
(23351, 3046, 22295, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:08', '2021-03-16 15:44:08'),
(23352, 1005, 22295, NULL, '2021-04-01 00:00:00.000', 'Approved', 'RHC-SPID got ancillary contract. No need to credential individual provider. Ref Task Link: http://app.emrbs.com/Credentials/Details/13652', NULL, NULL, '2021-03-25 14:18:06', '2021-03-25 14:18:06'),
(23353, 3040, 22296, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:44:51', '2021-03-16 15:44:51'),
(23354, 3040, 22296, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Email sent to:  SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Scott & White under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 12:30:38', '2021-04-02 12:30:38'),
(23355, 1006, 22296, NULL, '2021-04-09 00:00:00.000', 'Initiated', NULL, NULL, NULL, '2021-04-02 15:45:56', '2021-04-02 15:45:56'),
(23356, 3040, 22296, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned practice and providers in Scott & White.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-06 14:48:52', '2021-05-06 14:48:52'),
(23357, 3040, 22296, NULL, '2021-06-02 00:00:00.000', 'Not Eligible', 'Email rcvd from: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Dear Provider,  On 4/19/2021, the attached email was sent, providing the status of the application submitted on 4/2/2021.   Unfortunately, we have declined to contract with Ladot Healthcare at this time.  Feel free to reapply after 10/2/2021.  Thank you  Network Development 1206 West Campus Dr | MS-A4-126 | Temple, TX 76502 SWHPProviderNetworkDevelopment@bswhealth.org  ', NULL, NULL, '2021-05-26 09:12:30', '2021-05-26 09:12:30'),
(23358, 3040, 22297, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:01', '2021-03-16 15:45:01'),
(23359, 3040, 22297, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Email sent to:  SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Scott & White under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 12:30:43', '2021-04-02 12:30:43'),
(23360, 3040, 22297, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned practice and providers in Scott & White.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-06 14:49:04', '2021-05-06 14:49:04'),
(23361, 3040, 22297, NULL, '2021-06-02 00:00:00.000', 'Not Eligible', 'Email rcvd from: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Dear Provider,  On 4/19/2021, the attached email was sent, providing the status of the application submitted on 4/2/2021.   Unfortunately, we have declined to contract with Ladot Healthcare at this time.  Feel free to reapply after 10/2/2021.  Thank you  Network Development 1206 West Campus Dr | MS-A4-126 | Temple, TX 76502 SWHPProviderNetworkDevelopment@bswhealth.org  ', NULL, NULL, '2021-05-26 09:12:35', '2021-05-26 09:12:35'),
(23362, 3040, 22298, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:08', '2021-03-16 15:45:08'),
(23363, 3040, 22298, NULL, '2021-04-09 00:00:00.000', 'Initiated', 'Email sent to:  SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Scott & White under the below location.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you need any additional information please let me know. Waiting to hear from you soon.   Thank you', NULL, NULL, '2021-04-02 12:30:55', '2021-04-02 12:30:55'),
(23364, 3040, 22298, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Hello,   Hope you are doing well. I wanted to follow up regarding the enrollment status for the below mentioned practice and providers in Scott & White.   Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider 2:   Provider Name: Dada, Oladipo Provider NPI# 1760700223  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-06 14:49:00', '2021-05-06 14:49:00'),
(23365, 3040, 22298, NULL, '2021-06-02 00:00:00.000', 'Not Eligible', 'Email rcvd from: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Scott & White ||  Dear Provider,  On 4/19/2021, the attached email was sent, providing the status of the application submitted on 4/2/2021.   Unfortunately, we have declined to contract with Ladot Healthcare at this time.  Feel free to reapply after 10/2/2021.  Thank you  Network Development 1206 West Campus Dr | MS-A4-126 | Temple, TX 76502 SWHPProviderNetworkDevelopment@bswhealth.org  ', NULL, NULL, '2021-05-26 09:12:41', '2021-05-26 09:12:41'),
(23366, 3046, 22299, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:17', '2021-03-16 15:45:17'),
(23367, 3040, 22299, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Ayarzagoitia, Patrick A. || BCBS  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS for our group Statcare Minor Emergency Clinic (SPID) under the below location.  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 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, '2021-03-29 12:16:26', '2021-03-29 12:16:26'),
(23368, 3040, 22299, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS 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: 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: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 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, '2021-03-29 13:05:29', '2021-03-29 13:05:29'),
(23369, 3040, 22299, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com, Provider_Relations_South_Texas@bcbstx.com  Subject: Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS 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: 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: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 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 08:36:35', '2021-03-30 08:36:35'),
(23370, 1006, 22299, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:18', '2021-04-15 08:43:18'),
(23371, 1006, 22299, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Received following update:  \"PATRICK AYARZAGOITIA, APN 8LH078 issued 07/12/2019 and linked to STATCARE MINOR EMERGENCY CLINIC tax 460575924  In networks as of 04/27/2020 with BLUE ADVANTAGE HMO, BLUE ESSENTIALS HMO, BLUE CHOICE PPO, CHIP, HEALTHSELECT, MEDICARE ADVANTAGE PPO, TEXAS STARKIDS and TEXAS STAR PROGRAM.   He will be due for recredentialing in three years.   Thank you. \"  Attached for reference is location confirmation', NULL, NULL, '2021-04-27 08:44:39', '2021-04-27 08:44:39'),
(23372, 3046, 22300, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 15:45:22', '2021-03-16 15:45:22'),
(23373, 3040, 22300, NULL, '2021-04-05 00:00:00.000', 'Initiated', 'Email sent to: provider_relations_houston@bcbstx.com tx_standard_contracting_team@bcbstx.com  Subject:  Add Location || Statcare Minor Emergency Clinic || Providers || BCBS ||   Greetings,   Hope you are doing well. I wanted to add the providers in the BCBS 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: 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: 3817 South Padre Island Drive  Corpus Christi , TX 78415  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083 Additional Location: 500 E CAESAR  KINGSVILLE , TX 78363 (Not Showing on directory)  Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Additional Location: 4042 River Hill  Corpus Christi , TX 78410 Additional Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250 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, '2021-03-29 13:05:18', '2021-03-29 13:05:18');
