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
(14589, 11056, 20397, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status  18123058	PIMS Address		9/27/2021	Provider Information Change (PIC) Form	In Progress', NULL, NULL, '2021-09-27 16:28:31', '2021-09-27 16:28:31'),
(14590, 11056, 20397, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Ref code : 42435791000  Rep : Sarah C  Status:   Have to fax a form for additional location 512-514-4214.   Form has been faxed . Please see the attachment', NULL, NULL, '2021-10-08 13:20:38', '2021-10-08 13:20:38'),
(14591, 11056, 20397, NULL, '2021-10-25 00:00:00.000', 'In Process', 'The issue has been resolved and faxed them again with the corrected one.', NULL, NULL, '2021-10-18 15:40:08', '2021-10-18 15:40:08'),
(14592, 11056, 20397, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Ref code : 402556888000  Rep. : Sierra P  Status:  Request has been placed someone gonna contact us from provider relations dept. or credentialing team for the issue to be resolve  Contact no. : 800-925-9126 ', NULL, NULL, '2021-10-26 13:45:37', '2021-10-26 13:45:37'),
(14593, 11056, 20397, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Miesha   Status: Another Application has to be submitted.   Refcode: 42726745000  Applications have been faxed with a coversheet as well.', NULL, NULL, '2021-11-18 17:44:13', '2021-11-18 17:44:13'),
(14594, 11056, 20397, NULL, '2021-12-13 00:00:00.000', 'In Process', '	 Rep: Jermaine S   Status: The applications are in process. It will take around 2 weeks.   Interaction code: 42820232000', NULL, NULL, '2021-12-06 15:08:17', '2021-12-06 15:08:17'),
(14595, 11056, 20397, NULL, '2021-12-29 00:00:00.000', 'In Process', 'The Medicaid portal is under processing.', NULL, NULL, '2021-12-22 17:26:13', '2021-12-22 17:26:13'),
(14596, 19067, 20397, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: PEMSSupport@tmhp.com  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group  || MEDICAID ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with Medicaid.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:15:01', '2021-12-29 15:15:01'),
(14597, 3046, 20398, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:04:03', '2021-03-12 18:04:03'),
(14598, 1006, 20398, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted address addition request via TMHP website: \"Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action  	17833777	PIMS Address		6/8/2021	Provider Information Change (PIC) Form	In Progress	View	\"', NULL, NULL, '2021-06-08 09:15:58', '2021-06-08 09:15:58'),
(14599, 11056, 20398, NULL, '2021-07-06 00:00:00.000', 'Initiated', 'I have called at TMHP for inquiring about the enrollment status. She is going to fax us  a letter of Deficiency and why our application had been closed. Ref no. : 41728865000', NULL, NULL, '2021-06-28 16:43:19', '2021-06-28 16:43:19'),
(14600, 11056, 20398, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the letter of deficiency. We haven\'t received it yet', NULL, NULL, '2021-08-20 17:21:45', '2021-08-20 17:21:45'),
(14601, 11056, 20398, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Portal Ticket #  Application Name  Status Update Date         Transction Type	                   Status	   17833777	     PIMS Address		6/16/2021   Provider Information Change (PIC) Form	Closed	', NULL, NULL, '2021-09-15 10:25:14', '2021-09-15 10:25:14'),
(14602, 11056, 20398, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status  18123058	PIMS Address		9/27/2021	Provider Information Change (PIC) Form	In Progress', NULL, NULL, '2021-09-27 16:28:12', '2021-09-27 16:28:12'),
(14603, 11056, 20398, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Ref code : 42435791000  Rep : Sarah C  Status:   Have to fax a form for additional location 512-514-4214.   Form has been faxed . Please see the attachment', NULL, NULL, '2021-10-08 13:20:32', '2021-10-08 13:20:32'),
(14604, 11056, 20398, NULL, '2021-10-25 00:00:00.000', 'In Process', 'The issue has been resolved and faxed them again with the corrected one.', NULL, NULL, '2021-10-18 15:39:58', '2021-10-18 15:39:58'),
(14605, 11056, 20398, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Ref code : 402556888000  Rep. : Sierra P  Status:  Request has been placed someone gonna contact us from provider relations dept. or credentialing team for the issue to be resolve  Contact no. : 800-925-9126 ', NULL, NULL, '2021-10-26 13:45:43', '2021-10-26 13:45:43'),
(14606, 11056, 20398, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Miesha   Status: Another Application has to be submitted.   Refcode: 42726745000  Applications have been faxed with a coversheet as well.', NULL, NULL, '2021-11-18 17:44:07', '2021-11-18 17:44:07'),
(14607, 11056, 20398, NULL, '2021-12-13 00:00:00.000', 'In Process', '	 Rep: Jermaine S   Status: The applications are in process. It will take around 2 weeks.   Interaction code: 42820232000', NULL, NULL, '2021-12-06 15:08:25', '2021-12-06 15:08:25'),
(14608, 11056, 20398, NULL, '2021-12-29 00:00:00.000', 'In Process', 'The Medicaid portal is under processing.', NULL, NULL, '2021-12-22 17:26:06', '2021-12-22 17:26:06'),
(14609, 19067, 20398, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: PEMSSupport@tmhp.com  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group  || MEDICAID ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with Medicaid.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:14:59', '2021-12-29 15:14:59'),
(14610, 3046, 20399, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:05:20', '2021-03-12 18:05:20'),
(14611, 1005, 20399, NULL, '2021-06-09 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-01 16:19:46', '2021-06-01 16:19:46'),
(14612, 3046, 20400, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:06:37', '2021-03-12 18:06:37'),
(14613, 1005, 20400, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Medicare 1D9126', NULL, NULL, '2021-06-01 16:21:36', '2021-06-01 16:21:36'),
(14614, 3046, 20401, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:06:39', '2021-03-12 18:06:39'),
(14615, 1005, 20401, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Medicare 746150', NULL, NULL, '2021-06-01 16:22:16', '2021-06-01 16:22:16'),
(14616, 3046, 20404, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:12:18', '2021-03-12 18:12:18'),
(14617, 1006, 20404, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ MHT.Credentialing@molinahealthcare.com & MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Enrollment Query - Nasa HealthClinic - Molina  \'Hello,  I hope you\'re doing well, I wanted to verify if the following group and provider were enrolled and listed under both the mentioned addresses. The information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-08 13:30:29', '2021-06-08 13:30:29'),
(14618, 11056, 20404, NULL, '2021-07-02 00:00:00.000', 'Approved', 'Email received from : MHT.Credentialing@molinahealthcare.com  Sub: Enrollment Approved - Nasa Health Clinic - Molina   Yes this provider is cred complete effective 3/15/19 and I am showing tied to the two addresses listed below.', NULL, NULL, '2021-06-25 13:35:02', '2021-06-25 13:35:02'),
(14619, 3046, 20405, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:12:19', '2021-03-12 18:12:19'),
(14620, 1006, 20405, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ MHT.Credentialing@molinahealthcare.com & MHTX Provider Services MHTXProviderServices@molinahealthcare.com:  Sub: Enrollment Query - Nasa HealthClinic - Molina  \'Hello,  I hope you\'re doing well, I wanted to verify if the following group and provider were enrolled and listed under both the mentioned addresses. The information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-08 13:30:24', '2021-06-08 13:30:24'),
(14621, 11056, 20405, NULL, '2021-07-02 00:00:00.000', 'Approved', 'Email received from : MHT.Credentialing@molinahealthcare.com  Sub: Enrollment Approved - Nasa Health Clinic - Molina   Yes this provider is cred complete effective 3/15/19 and I am showing tied to the two addresses listed below.', NULL, NULL, '2021-06-25 13:34:47', '2021-06-25 13:34:47'),
(14622, 3046, 20406, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:12:48', '2021-03-12 18:12:48'),
(14623, 1006, 20406, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ registrar@multiplan.com:   Sub: Enrollment Query - NASA HealthClinic - Multiplan  \"Hello,   I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-08 08:57:31', '2021-06-08 08:57:31'),
(14624, 11056, 20406, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to :  registrar@multiplan.com  Sub : Enrollment Query - NASA Health Clinic - Multiplan  Hello,  I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider : Provider Name: Segun Adeoye NPI# : 1629418025  Please get back to me as soon as possible.  Thank you.', NULL, NULL, '2021-06-25 13:26:26', '2021-06-25 13:26:26'),
(14625, 1006, 20406, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Created new service case asking the same query, as Multiplan isn\'t responding to emails: Service Case(s) Created Service Case Number:	7672630 ', NULL, NULL, '2021-07-15 16:05:10', '2021-07-15 16:05:10'),
(14626, 11056, 20406, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : noreplycustserv@multiplan.com  Sub :  Fwd: Updated Customer Service Case 7672630  MultiPlan has added the following update to your Customer Service Case 7672630. We will keep you informed of further updates and resolution. You can check status and make updates to this case online.  Dear Brad Peterson,  Thank you for contacting our Service Department at MultiPlan. Here is the following information we have on file for Adeoye, Segun:  Network:  MPI and PHCS Network Participation effective: 3/21/2019 Contract Source Group contract through: NASA Health Clinic  Here is the following information we have on file for NASA Health Clinic:  Network:  MPI and PHCS Network Participation effective: 10/25/2015  Both provider and group have address 985 NASA Parkway, Houston, TX. 77058 listed as an active location.  If any demographic information needs to be updated, please fax the information to our Registrar Department at (781) 487-8273 or email Registrar@MultiPlan.com.  As a reminder under the MPI provider agreement, MultiPlan does not make determinations with respect to benefits or eligibility or pay claims.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7672630.  You may also re-open a case using the portal, if you have a further inquiry on the same case.    Case Number: 7672630    Submitter Name: Brad Peterson    Date of submission: 07/15/2021    TIN: 47-2682655    Provider Name: Adeoye, Segun Group Name: NASA Health Clinic Inquiry Type: Credentialing Status • Verify participation status    Priority: Standard', NULL, NULL, '2021-08-03 08:28:07', '2021-08-03 08:28:07'),
(14627, 11056, 20406, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Fwd: Updated Customer Service Case 7672630  Greetings,  Hope all is well. Thank you so much for your assistance. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:15:57', '2021-08-18 11:15:57'),
(14628, 11056, 20406, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  &  pif@multiplan.com  Sub : Fwd: Updated Customer Service Case 7672630  Good afternoon!  Hope all is well. Kindly, respond to my emails. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 13:54:28', '2021-08-27 13:54:28'),
(14629, 11056, 20406, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Participating with Multiplan as received details through recorder no rep. was available. Just want to verify eff dates.', NULL, NULL, '2021-09-16 17:09:56', '2021-09-16 17:09:56'),
(14630, 11056, 20406, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep. : SELENA P  Ref code : 7672630  Status:  Submit a  request on LOI at 781-487-8273  Follow-up procedure : Call them for the update at 800-950-7040 after 15 business days  regarding demographic updates.  Contact no. : 800-950-7040', NULL, NULL, '2021-09-29 10:34:10', '2021-09-29 10:34:10'),
(14631, 11056, 20406, NULL, '2021-10-19 00:00:00.000', 'Approved', 'Email received from : ProviderServices@multiplan.com & selena.pareja@multiplan.com  Sub : CC-Status Letter - Individual Provider  Dear Ahmed,  We received your request to email the participation status letter.  Please find the attached documents for Segun Adeoye.    You may check the status of your current inquiry by calling 800-950-7040 with reference to your Case # 7672630.  You may also submit a new inquiry via our website at https://custservice.multiplan.com (note there is no www.) for the link to request service online.  You may re-open a closed case using the Portal, if you have a further inquiry on the same case.  Sincerely,  Selena P. Service Advisor MultiPlan   Please see the attachment.', NULL, NULL, '2021-10-12 15:57:40', '2021-10-12 15:57:40'),
(14632, 3046, 20407, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:12:54', '2021-03-12 18:12:54'),
(14633, 1006, 20407, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ registrar@multiplan.com:   Sub: Enrollment Query - NASA HealthClinic - Multiplan  \"Hello,   I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-06-08 08:57:28', '2021-06-08 08:57:28'),
(14634, 11056, 20407, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to :  registrar@multiplan.com  Sub : Enrollment Query - NASA Health Clinic - Multiplan  Hello,  I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider : Provider Name: Segun Adeoye NPI# : 1629418025  Please get back to me as soon as possible.  Thank you.', NULL, NULL, '2021-06-25 13:26:40', '2021-06-25 13:26:40'),
(14635, 1006, 20407, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Created new service case asking the same query, as Multiplan isn\'t responding to emails: Service Case(s) Created Service Case Number:	7672630 ', NULL, NULL, '2021-07-15 16:05:14', '2021-07-15 16:05:14'),
(14636, 11056, 20407, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : noreplycustserv@multiplan.com  Sub :  Fwd: Updated Customer Service Case 7672630  MultiPlan has added the following update to your Customer Service Case 7672630. We will keep you informed of further updates and resolution. You can check status and make updates to this case online.  Dear Brad Peterson,  Thank you for contacting our Service Department at MultiPlan. Here is the following information we have on file for Adeoye, Segun:  Network:  MPI and PHCS Network Participation effective: 3/21/2019 Contract Source Group contract through: NASA Health Clinic  Here is the following information we have on file for NASA Health Clinic:  Network:  MPI and PHCS Network Participation effective: 10/25/2015  Both provider and group have address 985 NASA Parkway, Houston, TX. 77058 listed as an active location.  If any demographic information needs to be updated, please fax the information to our Registrar Department at (781) 487-8273 or email Registrar@MultiPlan.com.  As a reminder under the MPI provider agreement, MultiPlan does not make determinations with respect to benefits or eligibility or pay claims.  If you have any questions regarding your current inquiry, please contact our Customer Service department by calling 800-950-7040 with reference to your Case #7672630.  You may also re-open a case using the portal, if you have a further inquiry on the same case.    Case Number: 7672630    Submitter Name: Brad Peterson    Date of submission: 07/15/2021    TIN: 47-2682655    Provider Name: Adeoye, Segun Group Name: NASA Health Clinic Inquiry Type: Credentialing Status • Verify participation status    Priority: Standard', NULL, NULL, '2021-08-03 08:27:38', '2021-08-03 08:27:38'),
(14637, 11056, 20407, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Fwd: Updated Customer Service Case 7672630  Greetings,  Hope all is well. Thank you so much for your assistance. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-20 17:23:09', '2021-08-20 17:23:09'),
(14638, 11056, 20407, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  &  pif@multiplan.com  Sub : Fwd: Updated Customer Service Case 7672630  Good afternoon!  Hope all is well. Kindly, respond to my emails. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 13:54:10', '2021-08-27 13:54:10'),
(14639, 11056, 20407, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Participating with Multiplan as received details through recorder no rep. was available. Just want to verify eff dates.', NULL, NULL, '2021-09-16 17:09:46', '2021-09-16 17:09:46'),
(14640, 11056, 20407, NULL, '2021-10-06 00:00:00.000', 'Approved', 'Rep. : SELENA P  eff dates : 06/18/2019  Status : Approved and the address is listed below on the provider.  Ref code : 7672630   Contact no. : 800-950-7040   Please see the attachment.', NULL, NULL, '2021-09-29 10:26:41', '2021-09-29 10:26:41'),
(14641, 3046, 20408, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:13:12', '2021-03-12 18:13:12'),
(14642, 1006, 20408, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ Account Management - Corpus Christi AM.CorpusChristi@SuperiorHealthPlan.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Superior Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Superior Health and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:58:43', '2021-06-07 17:58:43'),
(14643, 1006, 20408, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Received the following response from Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Superior Health  \"Good afternoon Brad,  I hope all is well, I have included a SS with all the Providers associated with the TID#472682655 ,  with the address : Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   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 \"', NULL, NULL, '2021-06-28 09:35:47', '2021-06-28 09:35:47'),
(14644, 3046, 20409, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:13:17', '2021-03-12 18:13:17'),
(14645, 1006, 20409, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ Account Management - Corpus Christi AM.CorpusChristi@SuperiorHealthPlan.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Superior Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Superior Health and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:58:38', '2021-06-07 17:58:38'),
(14646, 1006, 20409, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Received the following response from Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Superior Health  \"Good afternoon Brad,  I hope all is well, I have included a SS with all the Providers associated with the TID#472682655 ,  with the address : Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   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 \"', NULL, NULL, '2021-06-28 09:36:05', '2021-06-28 09:36:05'),
(14647, 3046, 20410, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:13:36', '2021-03-12 18:13:36'),
(14648, 1006, 20410, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ TCHP CA Contract Admin TCHPnetworkmanagemen@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with TCHP and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:54:18', '2021-06-07 17:54:18'),
(14649, 1006, 20410, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"This is the contracting team, we are able to check the status of a Letter of interest or Provider information form. To check if you are in our network please reach out to either your PR or a  Provider assistance 832-828-1004 opt3. Thank you\"  Sent reply:   \"Hello,  Can you please inform us who our provider representative is so we can get in touch with them?  Thank you!\"', NULL, NULL, '2021-06-28 10:03:34', '2021-06-28 10:03:34'),
(14650, 11056, 20410, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Is your group in network? If so, what is your zip code?   Email replied to : tchpnetworkmanagement@texaschildrens.org  Hello,  Yes, the group should be in-network. The zip code for the main location is 77058.   Let me know if you have any other questions.  Thank you.', NULL, NULL, '2021-07-22 17:15:50', '2021-07-22 17:15:50'),
(14651, 11056, 20410, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:  Johnna Blount 346-319-7740 Jlblount@texaschildrens.org  Have a great day!  Marty', NULL, NULL, '2021-07-23 14:39:31', '2021-07-23 14:39:31'),
(14652, 11056, 20410, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org      &                                                  JLBlount@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  PR,  Please assist with inquiring below. This group is in network group looking for their assigned PR.  Thank you', NULL, NULL, '2021-07-28 09:25:16', '2021-07-28 09:25:16'),
(14653, 11056, 20410, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:     Johnna Blount  346-319-7740  Jlblount@texaschildrens.org     Have a great day!  Marty', NULL, NULL, '2021-08-17 09:28:11', '2021-08-17 09:28:11'),
(14654, 11056, 20410, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : providerrelations@texaschildrens.org  &  Jlblount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP Good Afternoon Johnna,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:23:00', '2021-08-26 16:23:00'),
(14655, 11056, 20410, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning Johnna!  Hope you are doing well. Here is the filled form for adding the additional location you requested for in the last email. Please see the attachment.  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 13:12:04', '2021-09-15 13:12:04'),
(14656, 11056, 20410, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email recived from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I do not personally make the changes, and I am not notified when the changes are made, but give it a week and check back with me.  Thanks,  Johnna Blount Provider Relations Texas Children’s Health Plan Ph #  409-543-3667 Fax#  832-825-8825', NULL, NULL, '2021-09-28 15:56:04', '2021-09-28 15:56:04'),
(14657, 11056, 20410, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good afternoon Johnna!  Hope you are doing well. It has been a month but you haven\'t informed me about the listing of secondary location. Please inform me soon. Has the secondary location been listed yet or not?  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-08 15:59:18', '2021-10-08 15:59:18'),
(14658, 11056, 20410, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hi Ahmed,  As you can see in my email below, I do not get notified, so I asked you to email me back to inquire.    I have checked and the secondary address has been added.   Thanks, Johnna', NULL, NULL, '2021-10-18 15:44:40', '2021-10-18 15:44:40'),
(14659, 11056, 20410, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP   Hey Johnna!  Hope this email finds you well. Please provide me with the Screenshot of the secondary location because I am unable to find it in the directory.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-10-25 16:55:33', '2021-10-25 16:55:33'),
(14660, 11056, 20410, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it in our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2021-11-11 13:01:39', '2021-11-11 13:01:39'),
(14661, 11056, 20410, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it to our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org   Waiting for the TMHP approval of the location.', NULL, NULL, '2021-11-29 13:23:54', '2021-11-29 13:23:54'),
(14662, 11056, 20410, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-03 18:03:13', '2021-12-03 18:03:13'),
(14663, 11056, 20410, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-20 10:28:51', '2021-12-20 10:28:51'),
(14664, 19067, 20410, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with TCHP.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:19:19', '2021-12-29 15:19:19'),
(14665, 19067, 20410, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||    Hi  Ahmed,  The secondary location has been added in our system, but the address is not attested to Dr. Adeoye or the group in the Master Provider File.  If you look up the NPI with TMHP, you will see that he nor the group is attested to this address; therefore, TCHP will not list it in the directory, nor will we pay claims billed with that address.     You need to call TMHP and get that address added to your information.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2022-01-06 09:56:12', '2022-01-06 09:56:12'),
(14666, 3046, 20411, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:13:41', '2021-03-12 18:13:41'),
(14667, 1006, 20411, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ TCHP CA Contract Admin TCHPnetworkmanagemen@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with TCHP and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:54:21', '2021-06-07 17:54:21'),
(14668, 1006, 20411, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following response from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment & Location Status Query - NASA HealthClinic - TCHP  \"This is the contracting team, we are able to check the status of a Letter of interest or Provider information form. To check if you are in our network please reach out to either your PR or a  Provider assistance 832-828-1004 opt3. Thank you\"  Sent reply:   \"Hello,  Can you please inform us who our provider representative is so we can get in touch with them?  Thank you!\"', NULL, NULL, '2021-06-28 10:03:24', '2021-06-28 10:03:24'),
(14669, 11056, 20411, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Is your group in network? If so, what is your zip code?   Email replied to : tchpnetworkmanagement@texaschildrens.org  Hello,  Yes, the group should be in-network. The zip code for the main location is 77058.   Let me know if you have any other questions.  Thank you.', NULL, NULL, '2021-07-22 17:15:05', '2021-07-22 17:15:05'),
(14670, 11056, 20411, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:  Johnna Blount 346-319-7740 Jlblount@texaschildrens.org  Have a great day!  Marty', NULL, NULL, '2021-07-23 14:39:18', '2021-07-23 14:39:18'),
(14671, 11056, 20411, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org      &                                                  JLBlount@texaschildrens.org  Sub : Enrollment & Location Status Query - NASA HealthClinic - TCHP  PR,  Please assist with inquiring below. This group is in network group looking for their assigned PR.  Thank you', NULL, NULL, '2021-07-28 09:24:55', '2021-07-28 09:24:55'),
(14672, 11056, 20411, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : providerrelations@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning! Your PR rep is:     Johnna Blount  346-319-7740  Jlblount@texaschildrens.org     Have a great day!  Marty', NULL, NULL, '2021-08-17 09:27:42', '2021-08-17 09:27:42'),
(14673, 11056, 20411, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : providerrelations@texaschildrens.org  &  Jlblount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP Good Afternoon Johnna,   I hope you\'re doing well. I wanted to inquire about the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:22:30', '2021-08-26 16:22:30'),
(14674, 11056, 20411, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good morning Johnna!  Hope you are doing well. Here is the filled form for adding the additional location you requested for in the last email. Please see the attachment.  Practice: Practice Name: Nasa Health Clinic Practice  NPI# 1740661453 Practice TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-15 13:12:14', '2021-09-15 13:12:14'),
(14675, 11056, 20411, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email recived from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I do not personally make the changes, and I am not notified when the changes are made, but give it a week and check back with me.  Thanks,  Johnna Blount Provider Relations Texas Children’s Health Plan Ph #  409-543-3667 Fax#  832-825-8825', NULL, NULL, '2021-09-28 15:55:49', '2021-09-28 15:55:49'),
(14676, 11056, 20411, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Good afternoon Johnna!  Hope you are doing well. It has been a month but you haven\'t informed me about the listing of secondary location. Please inform me soon. Has the secondary location been listed yet or not?  Thank you! Have a great week ahead!', NULL, NULL, '2021-10-08 15:58:59', '2021-10-08 15:58:59'),
(14677, 11056, 20411, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email received from : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hi Ahmed,  As you can see in my email below, I do not get notified, so I asked you to email me back to inquire.    I have checked and the secondary address has been added.   Thanks, Johnna', NULL, NULL, '2021-10-18 15:44:26', '2021-10-18 15:44:26'),
(14678, 11056, 20411, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP   Hey Johnna!  Hope this email finds you well. Please provide me with the Screenshot of the secondary location because I am unable to find it in the directory.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-10-25 16:55:21', '2021-10-25 16:55:21'),
(14679, 11056, 20411, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it in our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2021-11-11 13:00:55', '2021-11-11 13:00:55'),
(14680, 11056, 20411, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Sub : Re: Enrollment & Location Status Query - NASA HealthClinic - TCHP  Hello,  I am being told that if the provider’s NPI is not attested to the address through TMHP, we cannot add the second location.  I do not see where NASA Clinic or Dr. Adeoye is attested to this address.  We have added it to our system, but it cannot be added to the directory until it is attested.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org   Waiting for the TMHP approval of the location.', NULL, NULL, '2021-11-29 13:23:40', '2021-11-29 13:23:40'),
(14681, 11056, 20411, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-03 18:02:58', '2021-12-03 18:02:58'),
(14682, 11056, 20411, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Waiting for the TMHP updation of the address.', NULL, NULL, '2021-12-20 10:28:20', '2021-12-20 10:28:20'),
(14683, 19067, 20411, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||  Hello!  Hope you\'re doing really well.  I would like to know the enrollment status of the following Group & Provider with TCHP.  Group Name	NASA Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary & Billing Location	985 NASA Parkway Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 15:19:17', '2021-12-29 15:19:17'),
(14684, 19067, 20411, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: JLBlount@texaschildrens.org  Subject: Enrollment Status || NASA HC || Segun Adeoye & Group || TCHP ||    Hi  Ahmed,  The secondary location has been added in our system, but the address is not attested to Dr. Adeoye or the group in the Master Provider File.  If you look up the NPI with TMHP, you will see that he nor the group is attested to this address; therefore, TCHP will not list it in the directory, nor will we pay claims billed with that address.     You need to call TMHP and get that address added to your information.     Thanks,     Johnna Blount  Provider Relations Liaison  Texas Children’s Health Plan  Phone| 409-543-3667  Email|jlblount@texaschildrens.org', NULL, NULL, '2022-01-06 09:56:07', '2022-01-06 09:56:07'),
(14685, 3046, 20412, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:14:13', '2021-03-12 18:14:13'),
(14686, 1006, 20412, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA HealthClinic - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:50:29', '2021-06-08 08:50:29'),
(14687, 1006, 20412, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from trpndataentry@trpnppo.com:  Sub; RE: Enrollment Query - NASA HealthClinic - TRPN  \"Hi,  The group is enrolled, effective date 06/18/2015,  Could you send me the enrollment information for Adeoye, please?  Thank you,  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\"  Sent reply:   \"Hello Carlos,   Thank you for the update, please let me know what is required to proceed with Segun\'s enrollment?  Thanks again!\"', NULL, NULL, '2021-06-18 12:56:02', '2021-06-18 12:56:02'),
(14688, 1006, 20412, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following email from :  Sub: RE: Enrollment Query - NASA HC - TRPN  \"Hi Brad,  I have attach you the Provider Update Form,  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\"  The form was filled out and sent back to Carlos. Attached in the group task for reference. ', NULL, NULL, '2021-06-21 11:55:56', '2021-06-21 11:55:56'),
(14689, 1006, 20412, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com via TRPN portal (https://web1.zixmail.net/s/compose?b=trpn):  Sub: RE: Enrollment Query - NASA HealthClinic - TRPN  \"Hello Carlos,  I hope you\'re doing well, I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:   Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-08 12:28:21', '2021-07-08 12:28:21');
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
(14690, 11056, 20412, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Greetings,  I hope you\'re doing well. I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 05:41:40', '2021-07-20 05:41:40'),
(14691, 11056, 20412, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Greetings,  I hope you\'re doing well. I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-23 16:24:46', '2021-07-23 16:24:46'),
(14692, 11056, 20412, NULL, '2021-08-04 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Hi,     This request is completed,     Locations are listed,     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', NULL, NULL, '2021-07-28 10:02:09', '2021-07-28 10:02:09'),
(14693, 3046, 20413, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:14:14', '2021-03-12 18:14:14'),
(14694, 1006, 20413, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA HealthClinic - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:50:24', '2021-06-08 08:50:24'),
(14695, 1006, 20413, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from trpndataentry@trpnppo.com:  Sub; RE: Enrollment Query - NASA HealthClinic - TRPN  \"Hi,  The group is enrolled, effective date 06/18/2015,  Could you send me the enrollment information for Adeoye, please?  Thank you,  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\"  Sent reply:   \"Hello Carlos,   Thank you for the update, please let me know what is required to proceed with Segun\'s enrollment?  Thanks again!\"', NULL, NULL, '2021-06-18 12:55:56', '2021-06-18 12:55:56'),
(14696, 1006, 20413, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following email from :  Sub: RE: Enrollment Query - NASA HC - TRPN  \"Hi Brad,  I have attach you the Provider Update Form,  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\"  The form was filled out and sent back to Carlos. Attached in the group task for reference. ', NULL, NULL, '2021-06-21 11:55:45', '2021-06-21 11:55:45'),
(14697, 1006, 20413, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com via TRPN portal (https://web1.zixmail.net/s/compose?b=trpn):  Sub: RE: Enrollment Query - NASA HealthClinic - TRPN  \"Hello Carlos,  I hope you\'re doing well, I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:   Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able.  Thank you.\"', NULL, NULL, '2021-07-08 12:28:13', '2021-07-08 12:28:13'),
(14698, 11056, 20413, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Greetings,  I hope you\'re doing well. I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:  Practice Details: Practice Name: Nasa Health Clinic Practice NPI# : 1740661453 Practice TIN# : 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 05:41:25', '2021-07-20 05:41:25'),
(14699, 11056, 20413, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub : Enrollment Query - NASA HealthClinic - TRPN  Hi,     This request is completed,     Locations are listed,     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', NULL, NULL, '2021-07-23 16:21:29', '2021-07-23 16:21:29'),
(14700, 3046, 20414, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:14:36', '2021-03-12 18:14:36'),
(14701, 1006, 20414, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:45:24', '2021-06-07 17:45:24'),
(14702, 1006, 20414, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I wanted to get an update regarding the status of enrollment for the mentioned group. Please get back to me as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-06-28 09:31:31', '2021-06-28 09:31:31'),
(14703, 11056, 20414, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Afternoon Brad,  We show this group tax id as non-network and TRICARE certified who can see Tricare Beneficiaries with the following Tricare Plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-07-16 15:39:02', '2021-07-16 15:39:02'),
(14704, 11056, 20414, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Morning Ahmed,        Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry     As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary     •            Tricare Select   •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-20 13:44:56', '2021-07-20 13:44:56'),
(14705, 3046, 20415, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:14:45', '2021-03-12 18:14:45'),
(14706, 1006, 20415, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:45:15', '2021-06-07 17:45:15'),
(14707, 1006, 20415, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - Tricare  \"Hello Yvonne,  I wanted to get an update regarding the status of enrollment for the mentioned group. Please get back to me as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-06-28 09:31:34', '2021-06-28 09:31:34'),
(14708, 11056, 20415, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Afternoon Brad,  We show this group tax id as non-network and TRICARE certified who can see Tricare Beneficiaries with the following Tricare Plans.  Tricare Select Tricare for Life Tricare Reserve Select Tricare Retired Reserve Tricare Retired Reserved Tricare Young Adult  Thanks, Yvonne W. Wyatt, Humana Military TRICARE Community Liaison II Houston/Galveston', NULL, NULL, '2021-07-16 15:38:45', '2021-07-16 15:38:45'),
(14709, 11056, 20415, NULL, '2021-07-27 00:00:00.000', 'Not Eligible', 'Email received from : ywyatt@humana.com  Sub : Enrollment & Location Status Query - NASA HealthClinic - Tricare  Good Morning Ahmed,        Humana Military thanks you for your interest in joining the TRICARE East Region network to provide care for our beneficiaries.  At this time, we are not currently expanding our network based on your specialty and location within the East Region.  Please understand that every market is different based on the beneficiary population, and the types of services needed in a particular location.  We will continue to evaluate our network needs for your community, and will reach out to you should those needs change in the future. Thank you again for your inquiry     As a TRICARE certified non-network provider, you are authorized to provide care to TRICARE beneficiaries with the following TRICARE plans below:  The reimbursement should be 100% of CMAC https://www.health.mil/Military-Health-Topics/Business-Support/Rates-and-Reimbursement/TRICARE-Allowable-Charges. Providers must seek applicable copayments, cost-shares and deductibles from the beneficiary     •            Tricare Select   •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult        Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-20 13:44:37', '2021-07-20 13:44:37'),
(14710, 3046, 20416, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:15:00', '2021-03-12 18:15:00'),
(14711, 1006, 20416, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:49:59', '2021-06-07 17:49:59'),
(14712, 1006, 20416, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,   We are still waiting for a response regarding the enrollment status for the mentioned group and provider, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:49:32', '2021-06-28 09:49:32'),
(14713, 11056, 20416, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.      Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.  Greg Carte UnitedHealthcare Network Management Resource Team (NMRT)  Product roster has been attached. Please see the attachment for approval verification.', NULL, NULL, '2021-07-20 05:57:23', '2021-07-20 05:57:23'),
(14714, 11056, 20416, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from kathleen_m_mcnulty@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 group and provider 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.     If you have any questions or concerns about the content of this email, please do not reply to this email as they will be deleted, but rather email directly to: networkhelp@uhc.com  for further assistance; thank you.     For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.   For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation     Thank you,     Kathleen McNulty  Network Management Resource Team', NULL, NULL, '2021-07-23 16:58:11', '2021-07-23 16:58:11'),
(14715, 3046, 20417, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-12 18:15:01', '2021-03-12 18:15:01'),
(14716, 1006, 20417, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Health ClinicNPI# 1740661453TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:50:03', '2021-06-07 17:50:03'),
(14717, 1006, 20417, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA HealthClinic - UHC  \"Hello,   We are still waiting for a response regarding the enrollment status for the mentioned group and provider, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:49:28', '2021-06-28 09:49:28'),
(14718, 11056, 20417, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Thank you for contacting the Network Management Resource Team. The provider has been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.      Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.  Greg Carte UnitedHealthcare Network Management Resource Team (NMRT)  Product roster has been attached. Please see the attachment for approval verification.', NULL, NULL, '2021-07-20 05:55:28', '2021-07-20 05:55:28'),
(14719, 11056, 20417, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from kathleen_m_mcnulty@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 group and provider 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.     If you have any questions or concerns about the content of this email, please do not reply to this email as they will be deleted, but rather email directly to: networkhelp@uhc.com  for further assistance; thank you.     For all Mental Health contracting issues, please contact Mental Health at 877-614-0484.   For all Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy contracting issues, please contact Optum Physical Health at 800-873-4575.   Please Note:  Credentialing approval does not imply or guarantee participation with the health plans.  Approved and signed physician contracts are required for participation     Thank you,     Kathleen McNulty  Network Management Resource Team', NULL, NULL, '2021-07-23 16:58:27', '2021-07-23 16:58:27'),
(14720, 3046, 20667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:19:32', '2021-03-15 09:19:32'),
(14721, 1006, 20667, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent query @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 16:51:17', '2021-06-07 16:51:17'),
(14722, 1006, 20667, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,   I wanted to get an update regarding the enrollment status for our group and provider, please get back to me as soon as possible.  Thank you!\"  ', NULL, NULL, '2021-06-28 10:23:29', '2021-06-28 10:23:29'),
(14723, 11056, 20667, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : provider_relations_houston@bcbstx.com  Sub :   Enrollment & Location Status Query - NASA UrgentCare - BCBSTX : Case Number - 02586903  Hi Brad,  I am attaching a group roster for you with all the information you are requesting on it.  Thank you.', NULL, NULL, '2021-07-29 09:15:40', '2021-07-29 09:15:40'),
(14724, 3046, 20668, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:19:52', '2021-03-15 09:19:52'),
(14725, 1006, 20668, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent query @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with BCBSTX and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 16:51:11', '2021-06-07 16:51:11'),
(14726, 1006, 20668, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ ProfessionalProviderNetworkDept@bcbstx.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - BCBSTX  \"Hello,   I wanted to get an update regarding the enrollment status for our group and provider, please get back to me as soon as possible.  Thank you!\"  ', NULL, NULL, '2021-06-28 10:23:21', '2021-06-28 10:23:21'),
(14727, 11056, 20668, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : provider_relations_houston@bcbstx.com  Sub :   Enrollment & Location Status Query - NASA UrgentCare - BCBSTX : Case Number - 02586903  Hi Brad,  I am attaching a group roster for you with all the information you are requesting on it.  Thank you.', NULL, NULL, '2021-07-29 09:15:23', '2021-07-29 09:15:23'),
(14728, 3046, 20669, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:27:54', '2021-03-15 09:27:54'),
(14729, 1005, 20669, NULL, '2021-06-09 00:00:00.000', 'Approved', 'GROUP NAME	NASA URGENT CARE INC GROUP PTAN	DX2199 GROUP NPI	1821542432 BUSINESS STATE	TX EFFECTIVE DATE	09/11/2016', NULL, NULL, '2021-06-01 16:37:15', '2021-06-01 16:37:15'),
(14730, 3046, 20670, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:27:58', '2021-03-15 09:27:58'),
(14731, 1006, 20670, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment request @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:46:13', '2021-06-07 17:46:13'),
(14732, 1006, 20670, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following response from Tricare :Yvonne Wyatt ywyatt@humana.com ​  Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Good Morning Brad,  We show this provider as network. You can check network status by creating a log in on the Provider Portal using this link Provider Self-Service (humana-military.com)', NULL, NULL, '2021-06-28 09:23:27', '2021-06-28 09:23:27'),
(14733, 3046, 20671, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:00', '2021-03-15 09:28:00'),
(14734, 1006, 20671, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Account Management - Corpus Christi AM.CorpusChristi@SuperiorHealthPlan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Superior Health and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:59:45', '2021-06-07 17:59:45'),
(14735, 1006, 20671, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned group and provider. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-28 09:38:06', '2021-06-28 09:38:06'),
(14736, 11056, 20671, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : Semetra Brazle\' via Nasa Health & Urgent Care nasa@claimsmedinc.com  Sub : Signature requested on \"ECM 546265 NASA URGENT CARE  Semetra Brazle requests your signature on ECM 546265 NASA URGENT CARE  Review and sign  Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM  Reviewing and signing done through Adobe. Please see attachment ', NULL, NULL, '2021-07-23 17:13:55', '2021-07-23 17:13:55'),
(14737, 11056, 20671, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub  : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility and provider soon.  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 08:43:29', '2021-08-02 08:43:29'),
(14738, 11056, 20671, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub  : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility and provider soon.  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 10:57:04', '2021-08-02 10:57:04'),
(14739, 11056, 20671, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  Hope all is well. Are the Primary & secondary locations also listed & added under the practice Tax I.D?  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you have any questions or queries please let me know.   Thank you! Have a great day!', NULL, NULL, '2021-08-18 09:53:34', '2021-08-18 09:53:34'),
(14740, 11056, 20671, NULL, '2021-09-04 00:00:00.000', 'Approved', 'Approval Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good afternoon Ahmed  My apologies for the delay in response  Here is the information you requested Here is the locations under the Group TID  For the following Provider  eff date is : 06/01/2019', NULL, NULL, '2021-08-27 16:52:30', '2021-08-27 16:52:30'),
(14741, 3046, 20673, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:27', '2021-03-15 09:28:27'),
(14742, 1006, 20673, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Enrollment query submitted @ Enterprise.Credentialing@memorialhermann.org & MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Health Clinic - Memorial Hermann  \"Hello,  I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses, please let me  The information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you.\"', NULL, NULL, '2021-06-08 14:38:43', '2021-06-08 14:38:43'),
(14743, 11056, 20673, NULL, '2021-07-03 00:00:00.000', 'Initiated', 'Email sent to : Enterprise.Credentialing@memorialhermann.org  Sub : New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  Good Evening,   I hope you\'re doing well, I wanted to enroll the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to.  Thank you! Have a great day! ', NULL, NULL, '2021-06-25 16:18:38', '2021-06-25 16:18:38'),
(14744, 1006, 20673, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ Enterprise.Credentialing@memorialhermann.org:  Sub: New Provider Enrollment Request - NASA Urgent Care - Memorial Hermann  \"Hello,   I hope you\'re doing well, I\'m still waiting on an update regarding our request. Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 16:53:21', '2021-07-15 16:53:21'),
(14745, 1006, 20673, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following query from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Segun Adeoye, MD’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services? Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.  Best Regards, MHHP Network Contracting  MHH HealthPlan-Ins_SM_4C  Network Contracting Memorial Hermann Health Plan 929 Gessner Road, Suite 1500 Houston, TX 77024 MHHPContracting@memorialhermann.org\"  Responded to the queries. ', NULL, NULL, '2021-07-26 14:20:45', '2021-07-26 14:20:45'),
(14746, 11056, 20673, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Afternoon,   I hope you\'re doing well. I wanted to know the enrollment status of the following group and provider with the given addresses. The information is as follows:  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider : Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 14:09:19', '2021-08-02 14:09:19'),
(14747, 11056, 20673, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. We need answers to the additional questions that were sent on July 30, 2021 before we can move forward. Please see attached email.   Thank you.    Camilla', NULL, NULL, '2021-08-17 13:34:13', '2021-08-17 13:34:13'),
(14748, 11056, 20673, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. My apologies. I have received the additional information. The Urgent Care will be presented to our Network Access and Adequacy Committee this month. Once I receive a response from them, I will let you know.     Thank you.     Camilla', NULL, NULL, '2021-08-25 16:23:00', '2021-08-25 16:23:00'),
(14749, 11056, 20673, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Hey Camilla!  Hope you are doing well. Here is the information you requested for Nasa Health Clinic.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406   ·  List of services provided Walk in Clinic  · Do you provide Virtual Health Services? Yes, telehealth services are provided.  ·Current service area and/or list of locations 985 NASA Parkway, Houston, TX 77058-3039 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  ·List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) Name: Segun Adeoye NPI# 1629418025  ·What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years 0~99+ years  ·Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. N/A  ·Link to website N/A  ·Current W-9 Attached  ·Current quality and outcomes data N/A  ·Any additional information you would like presented to the Network Access and Adequacy Committee N/A', NULL, NULL, '2021-09-07 16:58:17', '2021-09-07 16:58:17'),
(14750, 11056, 20673, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning. I have received the executed agreement for NASA Urgent Care and that information has been forwarded to our credentialing team. However, I have not received the executed agreement for NASA Health Clinic. Please let me know that status of receiving that agreement.', NULL, NULL, '2021-09-15 17:00:05', '2021-09-15 17:00:05'),
(14751, 11056, 20673, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to :MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon!  Hope this email finds you well. We have already submitted that to you. If you haven\'t received it yet, Please let us know. Please provide that agreement back to us,so we will fill out that again and submit it to you.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 13:06:49', '2021-09-27 13:06:49'),
(14752, 11056, 20673, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good Evening!  Hope this email finds you well. Here are the filled and signed provider agreement,Schedule C Tables 1 and 2 and Schedule D. Please see the attachment.  Practice Details: Practice Name : Nasa Health Clinic Practice TIN # : 47-2682655 Practice NPI # : 1740661453 Primary Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you further need any additional information or documents please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-08 12:17:11', '2021-10-08 12:17:11'),
(14753, 11056, 20673, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to: MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good morning!  Hope all is well. Here it is. Please find the attached and completed agreement for Nasa Health Clinic.  Please do not hesitate to reach out if you have any questions or concerns. Please keep me updated with the enrollment process.  Thank you! Have a great day!', NULL, NULL, '2021-10-15 16:01:38', '2021-10-15 16:01:38'),
(14754, 11056, 20673, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email sent to : MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann  Good morning!  Hope you had a great and safe weekend. Please provide the latest updates regarding the agreement and credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025   If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day!', NULL, NULL, '2021-10-22 16:24:06', '2021-10-22 16:24:06'),
(14755, 11056, 20673, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from:  MHHPContracting@memorialhermann.org  Sub : Enrollment Query - NASA Urgent Care - Memorial Hermann   Good afternoon. Credentialing takes 30-45 days. Once I receive the credentialing approvals, I will send the agreement to my leadership team for full execution.', NULL, NULL, '2021-11-11 09:25:56', '2021-11-11 09:25:56'),
(14756, 11056, 20673, NULL, '2021-11-26 00:00:00.000', 'On Hold', 'Email received from:  jcalderon@symplr.com  Sub : RE: 3st & Final Request/ Memorial Hermann Health plan/ Nasa Urgent Care Inc   Hi Ahmed,     The Professional Liability that you forward previously is coverage for the provider only we are still pending the following documents:     Facility Professional Liability Insurance   Facility General Liability Insurance Business Licenses or Certificate of Occupancy Accreditation Certificate CLIA (If applicable) If you are not the person that handles the above documentation can you please direct me to who is.     Thank you,   Johanna Calderon                           Credentialing Specialist  Work: +1 (516) 593-1380 Ext. 287  Fax: 516-620-3054  Email: jcalderon@symplr.com symplr.com', NULL, NULL, '2021-11-19 11:22:30', '2021-11-19 11:22:30'),
(14757, 3046, 20674, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:29', '2021-03-15 09:28:29'),
(14758, 1006, 20674, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted address addition request via TMHP website: \" Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17833729	PIMS Address		6/8/2021	Provider Information Change (PIC) Form	In Progress	View	\"', NULL, NULL, '2021-06-08 09:08:36', '2021-06-08 09:08:36'),
(14759, 11056, 20674, NULL, '2021-07-06 00:00:00.000', 'Initiated', 'I have called at TMHP for inquiring about the enrollment status. She is going to fax us  a letter of Deficiency and why our application had been closed. Ref no. : 41728865000', NULL, NULL, '2021-06-28 16:43:22', '2021-06-28 16:43:22'),
(14760, 11056, 20674, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the letter of deficiency. We haven\'t received it yet', NULL, NULL, '2021-08-20 17:21:40', '2021-08-20 17:21:40'),
(14761, 11056, 20674, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Portal Ticket #  Application Name  Status Update Date         Transction Type	                   Status	   17833729	     PIMS Address		6/16/2021   Provider Information Change (PIC) Form	Closed	', NULL, NULL, '2021-09-15 09:55:52', '2021-09-15 09:55:52'),
(14762, 11056, 20674, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Successfully created Provider Information Change Transaction, transaction ID: 18123085.', NULL, NULL, '2021-09-27 16:36:14', '2021-09-27 16:36:14'),
(14763, 11056, 20674, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Ref code : 42435791000  Rep : Sarah C  Status:   Have to fax a form for additional location 512-514-4214.   Form has been faxed . Please see the attachment', NULL, NULL, '2021-10-08 13:19:52', '2021-10-08 13:19:52'),
(14764, 11056, 20674, NULL, '2021-10-25 00:00:00.000', 'In Process', 'The issue has been resolved and faxed them again with the corrected one.', NULL, NULL, '2021-10-18 15:39:50', '2021-10-18 15:39:50'),
(14765, 11056, 20674, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Ref code : 402556888000  Rep. : Sierra P  Status:  Request has been placed someone gonna contact us from provider relations dept. or credentialing team for the issue to be resolve  Contact no. : 800-925-9126 ', NULL, NULL, '2021-10-26 13:45:51', '2021-10-26 13:45:51'),
(14766, 11056, 20674, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Miesha   Status: Another Application has to be submitted.   Refcode: 42726745000  Applications have been faxed with a coversheet as well.', NULL, NULL, '2021-11-18 17:44:01', '2021-11-18 17:44:01'),
(14767, 11056, 20674, NULL, '2021-12-13 00:00:00.000', 'In Process', '	 Rep: Jermaine S   Status: The applications are in process. It will take around 2 weeks.   Interaction code: 42820232000', NULL, NULL, '2021-12-06 15:08:33', '2021-12-06 15:08:33'),
(14768, 11056, 20674, NULL, '2021-12-29 00:00:00.000', 'In Process', 'The Medicaid portal is under processing.', NULL, NULL, '2021-12-22 17:25:57', '2021-12-22 17:25:57'),
(14769, 3046, 20675, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:34', '2021-03-15 09:28:34'),
(14770, 1006, 20675, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrolment query @ info@usamco.com:  Sub: Enrollment Query - Nasa UrgentCare - MCO  \"Hello,  We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 14:54:52', '2021-06-08 14:54:52'),
(14771, 11056, 20675, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 12:14:12', '2021-06-25 12:14:12'),
(14772, 1006, 20675, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Query - Nasa Urgent Care - MCO  \"Hello,   I hope you\'re doing good, I wanted to get an update regarding the status of my request.   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 15:51:35', '2021-07-15 15:51:35'),
(14773, 11056, 20675, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from :  info@usamco.com  &   HIPOLITJ@usamco.com  Sub :  Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required.  To add addt’l locations to a facility record you will need to complete our MFA. Please see attachment for  Copy of our MFA. Please complete and fwd back so we add to facility’s record and requested location/s.  If any questions please let us know  Thank You, Jackie Hipolito Provider Relations.', NULL, NULL, '2021-07-16 13:28:01', '2021-07-16 13:28:01'),
(14774, 11056, 20675, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  &   info@usamco.com,  Sub : Enrollment Query - Nasa Urgent Care - MCO  Good Morning,  Hope you are doing well. Here is the filled and signed MFA for provider and group to addi additional locations to the facility . Please see the attachment.  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any information or documents further, please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 13:47:54', '2021-07-28 13:47:54'),
(14775, 11056, 20675, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Great, thank you the addt’l location site has been added effective 07/16/2021 per original update recv’d.  If any questions please contact us…a confirmation for you records.  Please see the attachment.', NULL, NULL, '2021-07-28 16:15:33', '2021-07-28 16:15:33'),
(14776, 3046, 20676, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:36', '2021-03-15 09:28:36'),
(14777, 1006, 20676, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ registrar@multiplan.com:  Sub: Enrollment Query - NASA UrgentCare - Multiplan  \"Hello,   I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:56:30', '2021-06-08 08:56:30');
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
(14778, 11056, 20676, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-06-25 12:57:03', '2021-06-25 12:57:03'),
(14779, 11056, 20676, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-06-30 08:43:53', '2021-06-30 08:43:53'),
(14780, 11056, 20676, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. https://custservice.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040  When submitting missing information please email the information to registrarmissinginfo@multiplan.com or via fax to 781-487-8278.  Phillip B. Provider Data Management registrarmissinginfo@multiplan.com  MultiPlan 16 Crosby Drive Bedford, MA 01730', NULL, NULL, '2021-07-19 17:06:06', '2021-07-19 17:06:06'),
(14781, 11056, 20676, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-07-30 17:15:22', '2021-07-30 17:15:22'),
(14782, 11056, 20676, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-08-18 11:09:14', '2021-08-18 11:09:14'),
(14783, 11056, 20676, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com &  james.darmawan@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Good morning!  Hope all is well. Thank you so much for your assistance. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 15:55:28', '2021-08-27 15:55:28'),
(14784, 11056, 20676, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Participating with Multiplan as received details through recorder no rep. was available. Just want to verify eff dates.', NULL, NULL, '2021-09-16 17:09:31', '2021-09-16 17:09:31'),
(14785, 11056, 20676, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep. : SELENA P  Ref code : 7672630  Status:  Submit a  request on LOI at 781-487-8273  Follow-up procedure : Call them for the update at 800-950-7040 after 15 business days  regarding demographic updates.  Contact no. : 800-950-7040', NULL, NULL, '2021-09-29 10:34:25', '2021-09-29 10:34:25'),
(14786, 11056, 20676, NULL, '2021-10-19 00:00:00.000', 'Approved', 'Email received from : ProviderServices@multiplan.com & selena.pareja@multiplan.com  Sub : CC-Status Letter - Individual Provider  Dear Ahmed,  We received your request to email the participation status letter.  Please find the attached documents for Segun Adeoye.    You may check the status of your current inquiry by calling 800-950-7040 with reference to your Case # 7672630.  You may also submit a new inquiry via our website at https://custservice.multiplan.com (note there is no www.) for the link to request service online.  You may re-open a closed case using the Portal, if you have a further inquiry on the same case.  Sincerely,  Selena P. Service Advisor MultiPlan   Please see the attachment.', NULL, NULL, '2021-10-12 15:57:09', '2021-10-12 15:57:09'),
(14787, 3046, 20677, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:40', '2021-03-15 09:28:40'),
(14788, 1006, 20677, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:35:19', '2021-06-07 17:35:19'),
(14789, 1006, 20677, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart   \"Hello,   We are still waiting to get an update regarding the status of enrollment for the mentioned group and provider on the previous email, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:42:25', '2021-06-28 09:42:25'),
(14790, 11056, 20677, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:54:41', '2021-07-19 16:54:41'),
(14791, 11056, 20677, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq.  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-02 08:59:56', '2021-08-02 08:59:56'),
(14792, 11056, 20677, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 10:45:03', '2021-08-18 10:45:03'),
(14793, 11056, 20677, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 10:45:14', '2021-08-18 10:45:14'),
(14794, 11056, 20677, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know. Eagerly, waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 11:04:11', '2021-08-27 11:04:11'),
(14795, 11056, 20677, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq. eff date is : 11/01/2018     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-31 16:46:51', '2021-08-31 16:46:51'),
(14796, 3046, 20678, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:42', '2021-03-15 09:28:42'),
(14797, 1006, 20678, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:09:27', '2021-06-07 18:09:27'),
(14798, 1006, 20678, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following update from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Good Morning Brad,  Upon review, we have determined Segun Adeoye and the group are participating providers under Tax id, 81-3237149. The effective date varies by line of business, which can be found highlighted on the attached Provider Profiles. Please see attached profiles for your records.  If further questions or concerns, feel free to advise.  Best Regards, Contracting Dept.\"  Sent reply:  \"Hello,   I appreciate the update, can you please let me know what is required to add the secondary addresses as well?   Thank you. \"', NULL, NULL, '2021-06-28 13:55:15', '2021-06-28 13:55:15'),
(14799, 11056, 20678, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon Brad,  In order to assist with the demographic update, we ask that you submit a formal written request on letterhead. Make sure to provide the office/fax number for the additional service location. If there is a change in the billing address, we will need a W-9 dated in 2021.  Should you have questions or need further assistance, feel free to advise.  Best Regards, Contracting Dept. ', NULL, NULL, '2021-07-20 06:09:30', '2021-07-20 06:09:30'),
(14800, 11056, 20678, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope you are doing well. Here is the letterhead with W9 which you have requested for the below mentioned group. Please see the attachments.    Practice: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 08:53:41', '2021-07-28 08:53:41'),
(14801, 11056, 20678, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon,     The Contracting Dept. is in receipt of the demographic request. Please allow up to fifteen business days to update the provider’s record.  Should you need further assistance, feel free to contact us.  Best Regards,  Contracting Team', NULL, NULL, '2021-08-17 08:25:18', '2021-08-17 08:25:18'),
(14802, 11056, 20678, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to  :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope all is well. I want to inquire about the enrollment status of the practice and providers mentioned below. Please provide me with the latest updates soon.  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider  Details: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information please let me know. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:36:25', '2021-08-26 16:36:25'),
(14803, 11056, 20678, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Segun Adeoye is currently participating under Nasa Urgent Care however is not linked to 985 NASA Parkway service location. Please follow up on request id #4985 and advise if additional information is needed to process the request.   Thank you ', NULL, NULL, '2021-09-15 12:04:33', '2021-09-15 12:04:33'),
(14804, 11056, 20678, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Rajika,   Please review ticket 4985 to create an amendment to add the new location to Nasa Urgent Care.   Kris', NULL, NULL, '2021-09-28 15:51:09', '2021-09-28 15:51:09'),
(14805, 11056, 20678, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Hi Ahmed,  Please provide a W9 signed in the current year, we are unable to proceed with update until that is received.  W-9 has been provided.', NULL, NULL, '2021-10-08 14:57:25', '2021-10-08 14:57:25'),
(14806, 11056, 20678, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-15 16:21:04', '2021-10-15 16:21:04'),
(14807, 11056, 20678, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Please follow up on request #4985 and advise if additional information is needed to process the demographic update.', NULL, NULL, '2021-10-22 16:51:07', '2021-10-22 16:51:07'),
(14808, 11056, 20678, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning:  The agreement is awaiting Executive Signature this week.  Once signed, it will be forwarded for loading.  Best Regards,', NULL, NULL, '2021-11-11 10:19:17', '2021-11-11 10:19:17'),
(14809, 11056, 20678, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good morning!  Hope all is well with you. Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Please get back to me as soon as possible. If you need any assistance from my side, I am happy to help.  Thank you!', NULL, NULL, '2021-11-19 10:34:57', '2021-11-19 10:34:57'),
(14810, 11056, 20678, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Kris.Olier@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope this email finds you well. Has your Mr.Executive got the time to sign our contracts yet or not? Any updates on the credentialing process for the provider and facility?  Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Waiting for your cooperation.  Thank you!', NULL, NULL, '2021-12-03 17:10:36', '2021-12-03 17:10:36'),
(14811, 11056, 20678, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good day:  They will be back in the office next week.  Once the agreement is signed, I will have the Contract Coordinator emailed it to you.  Best Regards,  Rajika​	 Reid Provider Contract Specialist Rajika.Reid@CommunityHealthChoice.org Phone: 713-295-2414 Fax: 713-295-7058', NULL, NULL, '2021-12-14 17:53:09', '2021-12-14 17:53:09'),
(14812, 19067, 20678, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Re: FW: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning!  Hope you are having a productive day. Have the agreements been signed as per your hope?  Kindly, provide the latest updates related to the contract and credentialing.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 09:30:11', '2021-12-29 09:30:11'),
(14813, 3046, 20679, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:44', '2021-03-15 09:28:44'),
(14814, 1006, 20679, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Enrollment query sent @ TX Credentialing txcredentialing@amerigroup.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:21:33', '2021-06-07 17:21:33'),
(14815, 1006, 20679, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"NASA Urgent Care is contracted as an Urgent Care, not a PCP clinic.  That means the facility bills globally (Rendering and Billing NPI are that of the clinic)  We do not have the 2nd location loaded.  Please include the phone, fax, office hours and age limits.  G#09758933\"  Sent following reply:   \"Hello,  I appreciate the reply, the requested information is as follows: Phone# 281-821-8200Fax# 718-640-2713 Office Hours: Mon-Fri: 9AM to 6PM & Sat: 9AM to 3PMAge Limits: None Please let me know if you have any other questions. Thank you!\"', NULL, NULL, '2021-06-28 10:58:05', '2021-06-28 10:58:05'),
(14816, 11056, 20679, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  The secondary location is still pending, no other information is needed.', NULL, NULL, '2021-07-16 14:14:46', '2021-07-16 14:14:46'),
(14817, 11056, 20679, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-02 09:14:08', '2021-08-02 09:14:08'),
(14818, 11056, 20679, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 09:40:21', '2021-08-18 09:40:21'),
(14819, 11056, 20679, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:37:03', '2021-08-27 09:37:03'),
(14820, 11056, 20679, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good evening!  Hope all is well. We are still waiting to get an update regarding the secondary location. Has the secondary location been added to the Group or not yet? It has been a long time since our emails were being ignored.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great week ahead!   Try to contact through call no one had received. Voice mail has been left out  for the updates.', NULL, NULL, '2021-09-23 17:07:47', '2021-09-23 17:07:47'),
(14821, 11056, 20679, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Still pending, I know this is taking a while, there is currently high volume.  I will see if I can get this moved along', NULL, NULL, '2021-10-08 09:59:07', '2021-10-08 09:59:07'),
(14822, 11056, 20679, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:35:48', '2021-10-18 15:35:48'),
(14823, 11056, 20679, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:37', '2021-10-25 16:52:37'),
(14824, 11056, 20679, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 13:14:06', '2021-11-11 13:14:06'),
(14825, 11056, 20679, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-19 10:22:35', '2021-11-19 10:22:35'),
(14826, 11056, 20679, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 18:00:47', '2021-12-03 18:00:47'),
(14827, 11056, 20679, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:42', '2021-12-14 17:46:42'),
(14828, 11056, 20679, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:24:44', '2021-12-20 10:24:44'),
(14829, 11056, 20679, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:42', '2021-12-23 09:38:42'),
(14830, 19067, 20679, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:05:36', '2021-12-30 14:05:36'),
(14831, 19067, 20679, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Re: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  This is my second reminder on the previously mentioned request.  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:41:35', '2022-01-07 23:41:35'),
(14832, 3046, 20680, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:28:45', '2021-03-15 09:28:45'),
(14833, 1006, 20680, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Humana  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Humana and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:26:55', '2021-06-07 17:26:55'),
(14834, 1006, 20680, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following response from HumanaHoustonPD@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Humana  \"This site is participating.  In addition to Segun Adeoye, Fernandus Limy is listed a participating with the group.  If this provider is no longer with the group, please provide the termination date.  Both addresses are correctly listed.  The following address is also listed:  1946 Pasadena Blvd Pasadena, TX 77502-2742  If these address is no longer valid, please provide the date this location was closed.  HumanaHoustonPD\"  Sent reply: \"Hello,   Appreciate the reply, could you please verify the effective dates for the group and providers?  Thank you!\"  ', NULL, NULL, '2021-06-28 10:10:30', '2021-06-28 10:10:30'),
(14835, 11056, 20680, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Humana  Please see the below directions provided to you on June 28th.  For details regarding provider status, you will need to follow the below process.           Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-07-30 17:09:24', '2021-07-30 17:09:24'),
(14836, 11056, 20680, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-17 14:38:36', '2021-08-17 14:38:36'),
(14837, 11056, 20680, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:26:01', '2021-08-26 16:26:01'),
(14838, 11056, 20680, NULL, '2021-09-03 00:00:00.000', 'Approved', 'I have words with Alyssa. She informed me with that the provider is loaded and linked to the TIN and participating in Humana plans Medicare PPO Medicare private C  Choice Care PPO Humana HMO Humana PPO  eff date is : 1 mar 2019  Rep name : Alyssa interaction no.  : 2000198360499  Please see the attachment', NULL, NULL, '2021-08-27 13:25:42', '2021-08-27 13:25:42'),
(14839, 3046, 20681, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:29:02', '2021-03-15 09:29:02'),
(14840, 1006, 20681, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Received following email from: Davis, Margie Y. (Margie) (mydavis@texaschildrens.org) Sub: RE: Need Status-Sugun-NASA UC  Luis,   We cannot add NASA Urgent Care since it shares the same address as NASA Health Clinic.  The provider can only be credentialed under the clinic at the time.   Thank you,', NULL, NULL, '2021-06-07 17:52:42', '2021-06-07 17:52:42'),
(14841, 3046, 20682, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:29:05', '2021-03-15 09:29:05'),
(14842, 1006, 20682, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:50:48', '2021-06-07 17:50:48'),
(14843, 1006, 20682, NULL, '2021-07-05 00:00:00.000', 'Approved', 'The provider is enrolled, the roster is attached for reference.   Eff: 06/01/2018 Provider ID# 3701044', NULL, NULL, '2021-06-28 09:55:31', '2021-06-28 09:55:31'),
(14844, 3046, 20683, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:29:07', '2021-03-15 09:29:07'),
(14845, 1006, 20683, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Cigna  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:06:31', '2021-06-07 17:06:31'),
(14846, 1006, 20683, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from :  Sub: Status Check W202106091738211  \"Dear Healthcare Professional,  As per the below request, We have mentioned the status for your reference.  PRACTICE NAME   CPF PROVIDER PID    TAX-ID         STATUS  Segun Adeoye                5883559       81-3237149  Participating  Note: Given Provider locations are already added.  Regards, PDM\"  Sent following reply:  \"Hello,   The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Thank you!\"', NULL, NULL, '2021-06-28 13:01:11', '2021-06-28 13:01:11'),
(14847, 11056, 20683, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:28:02', '2021-08-03 09:28:02'),
(14848, 11056, 20683, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : 	PDM COGZ  Sub :   Status Check- W202108041831586  Dear Healthcare Professional,     As per the below request, We have mentioned the status for your reference.     PRACTICE NAME/PROVIDER NAME  CPF PROVIDER PID  TAX-ID  STATUS  Nasa Urgent Care Inc  6647163  813237149  Active  Adeoye Segun  5883559  813237149  Active  Belakera Ramegowda  8912478  813237149  Term  Mathai Priya  1862263  813237149  Term   ', NULL, NULL, '2021-08-18 11:31:20', '2021-08-18 11:31:20'),
(14849, 11056, 20683, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  &  PSSCentral@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 17:19:11', '2021-08-27 17:19:11'),
(14850, 11056, 20683, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email received from : 	PDMCOGZ@cigna.com  Sub : Completion Notification - W202109091890831  Dear Healthcare Professional,  We received your recent request., We have mentioned the status for your reference.  GROUP NAME : Nasa Urgent Care Inc  CPF PROVIDER PID : 6647163  TAX-ID : 81-3237149    Addresses are active under the above mentioned TIN.  Regards, PDM', NULL, NULL, '2021-09-16 14:02:31', '2021-09-16 14:02:31'),
(14851, 11056, 20683, NULL, '2021-09-23 00:00:00.000', 'Not Eligible', 'Cigna don\'t approves the group which have only one provider as their policy. I had words with Dani & Racheal at 860-226-1848. Both has verified this policy  Ref code : 09162021', NULL, NULL, '2021-09-16 14:42:25', '2021-09-16 14:42:25'),
(14852, 3046, 20684, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:29:09', '2021-03-15 09:29:09'),
(14853, 1006, 20684, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'As per my discussion with Aetna we need to submit a location addition request via an LOI, it will take 30 business days to be updated. ', NULL, NULL, '2021-06-07 16:36:14', '2021-06-07 16:36:14'),
(14854, 1006, 20684, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent following LOI @ (859) 455-8650', NULL, NULL, '2021-06-28 15:52:33', '2021-06-28 15:52:33'),
(14855, 11056, 20684, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Aetna  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:15:56', '2021-07-30 16:15:56'),
(14856, 11056, 20684, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Aetna  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:20:41', '2021-08-18 11:20:41'),
(14857, 11056, 20684, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email received from : SoTXNetworkManagement25WS@aetna.com  Sub :  [EXTERNAL] Enrollment & Location Status Query - NASA Urgent Care - Aetna  Please note this mailbox is no longer being monitored     For timely resolution of your eligibility, benefits and claims questions, please contact our Provider or Customer Service Center by calling:  ·         Aetna  at 1-888-632-3862 for Indemnity and PPO based plans or 1-800-624-0756 for HMO based plans     New credentialing provider steps:  ·         Go to www.aetna.com  ·         Choose Health Care Professional  ·         Choose Join the Network  ·         Choose Medical Providers     Check on credentialing status at 1-800-353-1232.     For convenient real-time status and tools, log onto our secure Provider Websites:  ·         Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp  Coventry’s Secure Provider Website:  https://directprovider.com', NULL, NULL, '2021-08-27 17:24:36', '2021-08-27 17:24:36'),
(14858, 11056, 20684, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Eva   Effective date: NASA UC : 06/28/2021 NASA HC : 11/04/2019   Status : We have to FAX Letter of request or LOI at 859-455-8650 for the additional address to be listed below the provider.   Ref code. : 6044173727  Contact no. : 800-353-1232 & 859-455-8650', NULL, NULL, '2021-09-23 13:06:40', '2021-09-23 13:06:40'),
(14859, 11056, 20684, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:36:49', '2021-09-23 13:36:49'),
(14860, 11056, 20684, NULL, '2021-10-15 00:00:00.000', 'Approved', 'Rep : Louise G & Avy A  Status :  Approved , Linked to the TIN  NASA UC  & Segun Adeoye Eff date : 08/01/2019  Ref code :  6048475365 & 6047930364', NULL, NULL, '2021-10-08 10:45:14', '2021-10-08 10:45:14'),
(14861, 3046, 20685, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:16', '2021-03-15 09:38:16');
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
(14862, 1006, 20685, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in main UHC task, need to allow more time to process. ', NULL, NULL, '2021-06-07 17:51:25', '2021-06-07 17:51:25'),
(14863, 11056, 20685, NULL, '2021-08-04 00:00:00.000', 'Initiated', 'Email sent to : 	networkhelp@uhc.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - UHC  Good morning!  I hope you\'re doing well. I want to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 09:12:58', '2021-07-28 09:12:58'),
(14864, 11056, 20685, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to :  networkhelp@uhc.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - UHC  Good morning!  I hope you\'re doing well. I want to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider Details: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-17 09:21:36', '2021-08-17 09:21:36'),
(14865, 11056, 20685, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Approval Email received from : networkhelp@uhc.com  Sub : Secure Message from tracy_brooks@uhc.com  Thank you for contacting the Network Management Resource Team. The group and the provider have been linked to the TIN below. I’ve included the product roster showing the demographic information, lines of business, and effective dates.      Did you know that you can get a product listing at any time from our website? Please see the attached handout for more information. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     Please let us know if we can assist further via email.     Please do not reply directly to this email. Send all responses or questions pertaining to this email to networkhelp@uhc.com for further assistance.  If sent to tracy_brooks@uhc.com, it will be considered responded to already and will be deleted.     Thank You,     Tracy Brooks  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-08-26 17:04:04', '2021-08-26 17:04:04'),
(14866, 3046, 20686, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:21', '2021-03-15 09:38:21'),
(14867, 1006, 20686, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Submitted enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-06-07 18:04:25', '2021-06-07 18:04:25'),
(14868, 1006, 20686, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent a new f/u email @ credentialing@anci-care.com & ACS VIP Providers VIPproviders@anci-care.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Anci-Care   \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:30:26', '2021-06-28 13:30:26'),
(14869, 11056, 20686, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : VIPproviders@anci-care.com   &   credentialing@anci-care.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:27:46', '2021-07-19 16:27:46'),
(14870, 11056, 20686, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Brad,     Hi.     Please see attached for NASA Urgent Care Inc.     Email to my attention.   patti.davidson@healthsmart.com        Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-02 11:23:46', '2021-08-02 11:23:46'),
(14871, 11056, 20686, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:16:53', '2021-08-25 16:16:53'),
(14872, 11056, 20686, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com & Jennifer.Maligaya@healthsmart.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Sorry for the delay. Please accept my apology. Here are the forms you requested for the Ancillary contracting of Nasa Urgent Care Inc. Please find the attachment.  If further any additional information or documents are needed feel free to reach out to me. Waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-22 14:43:45', '2021-09-22 14:43:45'),
(14873, 11056, 20686, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Thank you!  This has been sent for processing and credentialing approval.  Once approved you will receive a welcome letter and the signed agreement from our credentialing department.   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:39:36', '2021-10-08 08:39:36'),
(14874, 11056, 20686, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the following facility and provider\'s credentialing process with Anci Care.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  Feel free to reach out to me if you have any questions or concerns.  Thank you! Have a blessed weekend!', NULL, NULL, '2021-10-15 16:54:47', '2021-10-15 16:54:47'),
(14875, 11056, 20686, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  This is in process with Credentialing for approval.     Thank you,   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-22 17:06:18', '2021-10-22 17:06:18'),
(14876, 11056, 20686, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good evening!  Hope this email finds you well. Any latest updates on the credentialing process. Is this approved by the credential department?  If you have any queries or concerns feel free to reach out to me.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 10:29:03', '2021-11-11 10:29:03'),
(14877, 11056, 20686, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:11:40', '2021-11-15 15:11:40'),
(14878, 3046, 20687, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:28', '2021-03-15 09:38:28'),
(14879, 1006, 20687, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrollment request via Wellmed website:  \"Thank you for your confidential inquiry. An executive from our development team will call you shortly.  http://www.joinwellmed.com/\"', NULL, NULL, '2021-06-08 14:46:04', '2021-06-08 14:46:04'),
(14880, 11056, 20687, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub :  Enrollment Request Status - NASA Urgent Care - Wellcare  Good Morning !  Hope you are doing well. I want to know the enrollment status of the provider and group mentioned below. We have already filled out the form starting this month. Waiting for your reply.  Practice: Practice name : Nasa Urgent Care Inc. Practice NPI :1821542432 Practice TIN : 81-3237149 Main Address : 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109,, Stafford , TX 77477-5406  Provider: Provider name : Adeoye, Segun P Provider NPI # : 1629418025  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 10:14:49', '2021-06-25 10:14:49'),
(14881, 11056, 20687, NULL, '2021-07-03 00:00:00.000', 'Not Eligible', 'Insurance is not eligible for enrollment', NULL, NULL, '2021-06-25 15:44:43', '2021-06-25 15:44:43'),
(14882, 3046, 20688, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:31', '2021-03-15 09:38:31'),
(14883, 1005, 20688, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Medicare ID: 1D9126 Eff Date: 02/20/2020', NULL, NULL, '2021-06-01 16:13:45', '2021-06-01 16:13:45'),
(14884, 3046, 20689, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:37', '2021-03-15 09:38:37'),
(14885, 1006, 20689, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA UrgentCare - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:40:28', '2021-06-07 17:40:28'),
(14886, 11056, 20689, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub :  CREDENTIALING DEPT - GALAXY HEALTH - NASA  Greetings,  Hope you are doing well. Enrollment form and documents are attached. please see the attachments.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  TIN# 81-3237149     Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406     Provider Name: Segun Adeoye  NPI# 1629418025   if you need any additional documents or details feel free to contact me.    Thank you!', NULL, NULL, '2021-06-25 09:09:39', '2021-06-25 09:09:39'),
(14887, 1006, 20689, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ Chris Guerue cguerue@ghn-mci.com:  Sub: RE: FW: CREDENTIALING DEPT - GALAXY HEALTH - NASA  \"Hello Chris,   I just wanted to verify if both the locations were listed under the group and provider, their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Thank you!\"', NULL, NULL, '2021-07-14 17:44:20', '2021-07-14 17:44:20'),
(14888, 11056, 20689, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to: cguerue@ghn-mci.com  Sub : CREDENTIALING DEPT - GALAXY HEALTH - NASA  Good Morning Chris,  Hope you are doing well. Please verify the enrollment of both locations. Are both locations also listed under the Practice?   Practice: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you have any questions please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 11:36:51', '2021-08-02 11:36:51'),
(14889, 11056, 20689, NULL, '2021-08-09 00:00:00.000', 'Approved', 'Email received from : cguerue@ghn-mci.com  Sub : Enrollment Request - NASA Urgent Care- Galaxy Health  There is a group agreement for NASA Urgent Care, the TIN is 813237149, Segun Adeoye was linked to this group and TIN eff 1/1/21 at the two locations listed below.  Please see the attachment.', NULL, NULL, '2021-08-02 13:31:06', '2021-08-02 13:31:06'),
(14890, 3046, 20690, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:39', '2021-03-15 09:38:39'),
(14891, 1006, 20690, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Scott & White and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:15:07', '2021-06-07 18:15:07'),
(14892, 1006, 20690, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Received following confirmation email from Scott & White:   \"Good morning,  TIN 813237149 is contracted in our system eff 10/15/2017 with both locations below.  This is a facility set up, so the provider would not be listed in our system under this TIN.  Please reach out to your provider rep for further assistance and to get specifics on the plans that you are currently contracted with.  If you are unsure who your rep is, please click on the link below to review our representative map and corresponding provider rep info.   https://swhp.org/Portals/0/Files/Forms/ProviderNews/SWHP-Provider-Relations-Representative-Territory-Map.pdf  Thank you so much,  Lacey B\"', NULL, NULL, '2021-06-28 08:53:40', '2021-06-28 08:53:40'),
(14893, 3046, 20691, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:41', '2021-03-15 09:38:41'),
(14894, 1006, 20691, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in Superior Health task, need to allow more time. ', NULL, NULL, '2021-06-07 18:01:06', '2021-06-07 18:01:06'),
(14895, 3046, 20692, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:44', '2021-03-15 09:38:44'),
(14896, 1006, 20692, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA UrgentCare - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:49:10', '2021-06-08 08:49:10'),
(14897, 1006, 20692, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from trpndataentry@trpnppo.com:  Sub; RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hi,  The group is enrolled, effective date 11/30/2016,  Could you send me the enrollment information for Adeoye, please?  Thank you,  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\"  Sent reply:   \"Hello Carlos,   I appreciate the reply, please let me know what enrollment information is required for Segun Adeoye?  Thank you!\"', NULL, NULL, '2021-06-18 12:51:59', '2021-06-18 12:51:59'),
(14898, 1006, 20692, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following email from :  Sub: RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hi Brad,  I have attach you the Provider Update Form,  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\"  The form was filled out and sent back to Carlos. Attached in the group task for reference. ', NULL, NULL, '2021-06-21 11:55:21', '2021-06-21 11:55:21'),
(14899, 1006, 20692, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com via TRPN portal (https://web1.zixmail.net/s/compose?b=trpn):  Sub: RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hello Carlos,  I hope you\'re doing well, I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:   Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-07-08 12:26:29', '2021-07-08 12:26:29'),
(14900, 11056, 20692, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub :  Enrollment Query - NASA UrgentCare - TRPN  Greetings,  I hope you\'re doing well. I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 05:37:58', '2021-07-20 05:37:58'),
(14901, 11056, 20692, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub  : Enrollment Query - NASA UrgentCare - TRPN  Hi,     This request is completed,     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  Please see attachment.', NULL, NULL, '2021-07-23 16:29:45', '2021-07-23 16:29:45'),
(14902, 3046, 20693, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:38:46', '2021-03-15 09:38:46'),
(14903, 1006, 20693, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ dhpcontracting@dchstx.org:  Sub: Enrollment Query - Nasa UrgentCare - Driscoll  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with Driscoll, if not please let me know what is required to proceed with the enrollment request, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 13:18:02', '2021-06-08 13:18:02'),
(14904, 11056, 20693, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'Email received from : Melinda.Lopez@dchstx.org  Sub : Enrollment Query - Nasa Urgent Care - Driscoll  Hello Brad, I wanted to acknowledge receipt of your request for contract however Houston and Stafford are not in our service area.     Please note that our service areas consists of the counties listed below:     Driscoll Health Plan Service Area  Nueces Service Area:  Kenedy  Brooks  Kleberg  Jim Wells  Nueces  San Patricio  Live Oak  Bee  Refugio  Aransas Pass  Calhoun  Goliad  Bee  Karnes  Victoria     Contiguous Counties:  Atascosa  Dewitt     Hidalgo Service Area:  Cameron  Hidalgo  Willacy  Starr  Jim Hogg  Zapata  Webb  Maverick  McMullen  Duval     Feel  free to contact me should you have any questions.     Thanks', NULL, NULL, '2021-06-25 10:54:43', '2021-06-25 10:54:43'),
(14905, 3046, 20694, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:48:05', '2021-03-15 09:48:05'),
(14906, 1006, 20694, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ pdsdallas@aetna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hello,   I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with First Health and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:14:24', '2021-06-07 17:14:24'),
(14907, 1006, 20694, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,   Good Afternoon!  Please find the status of the below Provider  PROVIDER NAME  CPD ID  TAX ID  NPI  EFFECTIVE DATE  Status  Segun Adeoye  2679981  81-3237149  1629418025  12/01/2019  Active  Thank you, Phani\"  Sent reply:   \"Hello Phani,   I appreciate the update, could you please let me know if both the mentioned practice addresses are also loaded under the group and provider?  Thanks.\"', NULL, NULL, '2021-06-28 13:18:04', '2021-06-28 13:18:04'),
(14908, 1006, 20694, NULL, '2021-07-15 00:00:00.000', 'Approved', 'We received the following update from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,  Both the addresses have been updated under the given TIN# 81-3237149 & Group.  Thank You,\"  Eff: 12/01/2019', NULL, NULL, '2021-07-08 12:33:21', '2021-07-08 12:33:21'),
(14909, 3046, 20695, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:57:39', '2021-03-15 09:57:39'),
(14910, 1006, 20695, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'As per my discussion with Aetna we need to submit a location addition request via an LOI, it will take 30 business days to be updated. ', NULL, NULL, '2021-06-07 16:36:09', '2021-06-07 16:36:09'),
(14911, 1006, 20695, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent following LOI @ (859) 455-8650', NULL, NULL, '2021-06-28 15:52:48', '2021-06-28 15:52:48'),
(14912, 11056, 20695, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Aetna  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 16:15:41', '2021-07-30 16:15:41'),
(14913, 11056, 20695, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : SoTXNetworkManagement25WS@aetna.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Aetna  Good Afternoon!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:20:29', '2021-08-18 11:20:29'),
(14914, 11056, 20695, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email received from : SoTXNetworkManagement25WS@aetna.com  Sub :  [EXTERNAL] Enrollment & Location Status Query - NASA Urgent Care - Aetna  Please note this mailbox is no longer being monitored     For timely resolution of your eligibility, benefits and claims questions, please contact our Provider or Customer Service Center by calling:  ·         Aetna  at 1-888-632-3862 for Indemnity and PPO based plans or 1-800-624-0756 for HMO based plans     New credentialing provider steps:  ·         Go to www.aetna.com  ·         Choose Health Care Professional  ·         Choose Join the Network  ·         Choose Medical Providers     Check on credentialing status at 1-800-353-1232.     For convenient real-time status and tools, log onto our secure Provider Websites:  ·         Aetna’s Secure Provider Website:  https://navinet.navimedix.com/Main.asp  Coventry’s Secure Provider Website:  https://directprovider.com', NULL, NULL, '2021-08-27 17:23:58', '2021-08-27 17:23:58'),
(14915, 11056, 20695, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Rep : Eva   Effective date: NASA UC : 06/28/2021 NASA HC : 11/04/2019   Status : We have to FAX Letter of request or LOI at 859-455-8650 for the additional address to be listed below the provider.   Ref code. : 6044173727  Contact no. : 800-353-1232 & 859-455-8650', NULL, NULL, '2021-09-23 13:05:52', '2021-09-23 13:05:52'),
(14916, 11056, 20695, NULL, '2021-09-30 00:00:00.000', 'In Process', 'LOI has been faxed at 859-455-8650  Please see the attachment.', NULL, NULL, '2021-09-23 13:37:33', '2021-09-23 13:37:33'),
(14917, 11056, 20695, NULL, '2021-10-15 00:00:00.000', 'Approved', 'Rep : Louise G & Avy A  Status :  Approved , Linked to the TIN  NASA UC  & Segun Adeoye Eff date : 08/01/2019  Ref code :  6048475365 & 6047930364', NULL, NULL, '2021-10-08 10:44:53', '2021-10-08 10:44:53'),
(14918, 3046, 20696, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:57:42', '2021-03-15 09:57:42'),
(14919, 1006, 20696, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Cigna  \"Hello,  I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with Cigna and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:06:25', '2021-06-07 17:06:25'),
(14920, 1006, 20696, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from :  Sub: Status Check W202106091738211  \"Dear Healthcare Professional,  As per the below request, We have mentioned the status for your reference.  PRACTICE NAME   CPF PROVIDER PID    TAX-ID         STATUS  Segun Adeoye                5883559       81-3237149  Participating  Note: Given Provider locations are already added.  Regards, PDM\"  Sent following reply:  \"Hello,   The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Thank you!\"', NULL, NULL, '2021-06-28 13:00:48', '2021-06-28 13:00:48'),
(14921, 11056, 20696, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 09:27:28', '2021-08-03 09:27:28'),
(14922, 11056, 20696, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email received from : 	PDM COGZ  Sub :   Status Check- W202108041831586  Dear Healthcare Professional,     As per the below request, We have mentioned the status for your reference.     PRACTICE NAME/PROVIDER NAME  CPF PROVIDER PID  TAX-ID  STATUS  Nasa Urgent Care Inc  6647163  813237149  Active  Adeoye Segun  5883559  813237149  Active  Belakera Ramegowda  8912478  813237149  Term  Mathai Priya  1862263  813237149  Term ', NULL, NULL, '2021-08-18 11:31:55', '2021-08-18 11:31:55'),
(14923, 11056, 20696, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email sent to : 	PDMCOGZ@cigna.com  &  PSSCentral@cigna.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Cigna  Good morning!  Hope all is well.The locations aren\'t showing up on the Cigna provider directory for the group and provider, please let me know what is required to get that updated?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Eagerly waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-27 17:18:56', '2021-08-27 17:18:56'),
(14924, 11056, 20696, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email received from : 	PDMCOGZ@cigna.com  Sub : Completion Notification - W202109091890831  Dear Healthcare Professional,  We received your recent request., We have mentioned the status for your reference.  GROUP NAME : Nasa Urgent Care Inc  CPF PROVIDER PID : 6647163  TAX-ID : 81-3237149    Addresses are active under the above mentioned TIN.  Regards, PDM', NULL, NULL, '2021-09-16 14:02:02', '2021-09-16 14:02:02'),
(14925, 11056, 20696, NULL, '2021-09-23 00:00:00.000', 'Approved', 'I had words with Dani & Racheal at 860-226-1848. She has verified the eff date : 10/16/2019   Please see the attachment.', NULL, NULL, '2021-09-16 14:40:02', '2021-09-16 14:40:02'),
(14926, 3046, 20697, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:57:45', '2021-03-15 09:57:45'),
(14927, 1006, 20697, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ NMRT networkhelp@uhc.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - UHC  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with UHC and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:50:43', '2021-06-07 17:50:43'),
(14928, 1006, 20697, NULL, '2021-07-05 00:00:00.000', 'Approved', 'The provider is enrolled, the roster is attached for reference.   Eff: 06/01/2018', NULL, NULL, '2021-06-28 09:53:39', '2021-06-28 09:53:39'),
(14929, 3046, 20698, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:57:51', '2021-03-15 09:57:51'),
(14930, 1006, 20698, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment query @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Humana  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Humana and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:26:50', '2021-06-07 17:26:50'),
(14931, 1006, 20698, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following response from HumanaHoustonPD@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Humana  \"This site is participating.  In addition to Segun Adeoye, Fernandus Limy is listed a participating with the group.  If this provider is no longer with the group, please provide the termination date.  Both addresses are correctly listed.  The following address is also listed:  1946 Pasadena Blvd Pasadena, TX 77502-2742  If these address is no longer valid, please provide the date this location was closed.  HumanaHoustonPD\"  Sent reply: \"Hello,   Appreciate the reply, could you please verify the effective dates for the group and providers?  Thank you!\"  ', NULL, NULL, '2021-06-28 10:10:26', '2021-06-28 10:10:26'),
(14932, 11056, 20698, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Humana  Please see the below directions provided to you on June 28th.  For details regarding provider status, you will need to follow the below process.           Please see item highlighted in yellow.      Please read the following instructions carefully:     For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-07-30 17:09:06', '2021-07-30 17:09:06'),
(14933, 11056, 20698, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-17 14:40:21', '2021-08-17 14:40:21'),
(14934, 11056, 20698, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : humanaproviderservices@humana.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Humana  Good morning!  I hope you\'re doing well. Could you please let me know what the effective date is for the group and mentioned provider?  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider: Provider Name: Segun Adeoye Provider NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:25:52', '2021-08-26 16:25:52'),
(14935, 11056, 20698, NULL, '2021-09-03 00:00:00.000', 'Approved', 'I have words with Alyssa. She informed me with that the provider is loaded and linked to the TIN and participating in Humana plans Medicare PPO Medicare private C  Choice Care PPO Humana HMO Humana PPO  eff date is : 1 mar 2019  Rep name : Alyssa interaction no.  : 2000198360499  Please see the attachment  ', NULL, NULL, '2021-08-27 13:25:20', '2021-08-27 13:25:20'),
(14936, 3046, 20699, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:57:54', '2021-03-15 09:57:54'),
(14937, 1006, 20699, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ CHC Contracting CHC.Contracting@CommunityHealthChoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Community Health Choice and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:09:21', '2021-06-07 18:09:21'),
(14938, 1006, 20699, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following update from CHC Contracting CHC.Contracting@communityhealthchoice.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  \"Good Morning Brad,  Upon review, we have determined Segun Adeoye and the group are participating providers under Tax id, 81-3237149. The effective date varies by line of business, which can be found highlighted on the attached Provider Profiles. Please see attached profiles for your records.  If further questions or concerns, feel free to advise.  Best Regards, Contracting Dept.\"  Sent reply:  \"Hello,   I appreciate the update, can you please let me know what is required to add the secondary addresses as well?   Thank you. \"', NULL, NULL, '2021-06-28 13:55:06', '2021-06-28 13:55:06'),
(14939, 11056, 20699, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon Brad,  In order to assist with the demographic update, we ask that you submit a formal written request on letterhead. Make sure to provide the office/fax number for the additional service location. If there is a change in the billing address, we will need a W-9 dated in 2021.  Should you have questions or need further assistance, feel free to advise.  Best Regards, Contracting Dept.', NULL, NULL, '2021-07-20 06:09:00', '2021-07-20 06:09:00'),
(14940, 11056, 20699, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : CHC.Contracting@communityhealthchoice.org  Sub : Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope you are doing well. Here is the letterhead with W9 which you have requested for the below mentioned group. Please see the attachments.    Practice: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 08:53:24', '2021-07-28 08:53:24'),
(14941, 11056, 20699, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Afternoon,     The Contracting Dept. is in receipt of the demographic request. Please allow up to fifteen business days to update the provider’s record.  Should you need further assistance, feel free to contact us.  Best Regards,  Contracting Team', NULL, NULL, '2021-08-17 08:19:52', '2021-08-17 08:19:52'),
(14942, 11056, 20699, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to  :  CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope all is well. I want to inquire about the enrollment status of the practice and providers mentioned below. Please provide me with the latest updates soon.  Practice Details: Practice  Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Practice  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Practice  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Practice Phone # : 2812186777 Practice Fax # : 8666656208  Provider  Details: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information please let me know. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-26 16:36:04', '2021-08-26 16:36:04'),
(14943, 11056, 20699, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Segun Adeoye is currently participating under Nasa Urgent Care however is not linked to 985 NASA Parkway service location. Please follow up on request id #4985 and advise if additional information is needed to process the request.   Thank you  ', NULL, NULL, '2021-09-15 12:04:17', '2021-09-15 12:04:17'),
(14944, 11056, 20699, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Rajika,   Please review ticket 4985 to create an amendment to add the new location to Nasa Urgent Care.   Kris', NULL, NULL, '2021-09-28 15:50:49', '2021-09-28 15:50:49'),
(14945, 11056, 20699, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Hi Ahmed,  Please provide a W9 signed in the current year, we are unable to proceed with update until that is received.  ', NULL, NULL, '2021-10-08 14:56:46', '2021-10-08 14:56:46'),
(14946, 11056, 20699, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email received  from : Kris.Olier@CommunityHealthChoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good afternoon!  Hope all is well with you. Please provide the latest updates regarding the credentialing of the practice and provider mentioned below as soon as possible.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or need any additional information please let me know. Eagerly waiting to hear from you.  Thank you! Have a great day! ', NULL, NULL, '2021-10-15 16:20:21', '2021-10-15 16:20:21'),
(14947, 11056, 20699, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning Kris,   Please follow up on request #4985 and advise if additional information is needed to process the demographic update.', NULL, NULL, '2021-10-22 16:50:50', '2021-10-22 16:50:50'),
(14948, 11056, 20699, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning:  The agreement is awaiting Executive Signature this week.  Once signed, it will be forwarded for loading.  Best Regards,', NULL, NULL, '2021-11-11 10:19:05', '2021-11-11 10:19:05'),
(14949, 11056, 20699, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good morning!  Hope all is well with you. Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Please get back to me as soon as possible. If you need any assistance from my side, I am happy to help.  Thank you!', NULL, NULL, '2021-11-19 10:34:40', '2021-11-19 10:34:40');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(14950, 11056, 20699, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  Kris.Olier@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good morning!  Hope this email finds you well. Has your Mr.Executive got the time to sign our contracts yet or not? Any updates on the credentialing process for the provider and facility?  Could you please provide me with the time frame for the signatures because you have already been taken along for that?  Waiting for your cooperation.  Thank you!', NULL, NULL, '2021-12-03 17:10:20', '2021-12-03 17:10:20'),
(14951, 11056, 20699, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Sub:  Fwd: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice   Good day:  They will be back in the office next week.  Once the agreement is signed, I will have the Contract Coordinator emailed it to you.  Best Regards,  Rajika​	 Reid Provider Contract Specialist Rajika.Reid@CommunityHealthChoice.org Phone: 713-295-2414 Fax: 713-295-7058', NULL, NULL, '2021-12-14 17:52:57', '2021-12-14 17:52:57'),
(14952, 19067, 20699, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email sent to: Rajika.Reid@communityhealthchoice.org  Subject: Re: FW: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice  Good Morning!  Hope you are having a productive day. Have the agreements been signed as per your hope?  Kindly, provide the latest updates related to the contract and credentialing.  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-29 09:30:20', '2021-12-29 09:30:20'),
(14953, 19067, 20699, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email received from: Rajika.Reid@communityhealthchoice.org  Subject: Re: FW: Enrollment & Location Status Query - NASA UrgentCare - Community Health Choice    Good morning:  The amendment was signed and the effective date is 12/7/2021.     Rajika​	 Reid Provider Contract Specialist Rajika.Reid@CommunityHealthChoice.org Phone: 713-295-2414 Fax: 713-295-7058 ', NULL, NULL, '2022-01-07 20:14:22', '2022-01-07 20:14:22'),
(14954, 3046, 20700, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:58:02', '2021-03-15 09:58:02'),
(14955, 1006, 20700, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following query @ pdsdallas@aetna.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hello,   I hope you\'re doing well, we wanted to verify if the following groups and provider were enrolled with First Health and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:14:21', '2021-06-07 17:14:21'),
(14956, 1006, 20700, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,   Good Afternoon!  Please find the status of the below Provider  PROVIDER NAME  CPD ID  TAX ID  NPI  EFFECTIVE DATE  Status  Segun Adeoye  2679981  81-3237149  1629418025  12/01/2019  Active  Thank you, Phani\"  Sent reply:   \"Hello Phani,   I appreciate the update, could you please let me know if both the mentioned practice addresses are also loaded under the group and provider?  Thanks.\"', NULL, NULL, '2021-06-28 13:17:41', '2021-06-28 13:17:41'),
(14957, 1006, 20700, NULL, '2021-07-15 00:00:00.000', 'Approved', 'We received the following update from Madiraju, Phani X MadirajuP@aetna.com:  Sub; Enrollment & Location Status Query - NASA UrgentCare - First Health  \"Hi,  Both the addresses have been updated under the given TIN# 81-3237149 & Group.  Thank You,\"  Eff: 12/01/2019', NULL, NULL, '2021-07-08 12:33:39', '2021-07-08 12:33:39'),
(14958, 3046, 20701, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:58:51', '2021-03-15 09:58:51'),
(14959, 1006, 20701, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Received following email from: Davis, Margie Y. (Margie) (mydavis@texaschildrens.org) Sub: RE: Need Status-Sugun-NASA UC  Luis,   We cannot add NASA Urgent Care since it shares the same address as NASA Health Clinic.  The provider can only be credentialed under the clinic at the time.   Thank you,', NULL, NULL, '2021-06-07 17:52:34', '2021-06-07 17:52:34'),
(14960, 3046, 20702, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:58:59', '2021-03-15 09:58:59'),
(14961, 1006, 20702, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Enrollment query sent @ TX Credentialing txcredentialing@amerigroup.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:21:27', '2021-06-07 17:21:27'),
(14962, 1006, 20702, NULL, '2021-07-05 00:00:00.000', 'In Process', 'We received the following reply from TX Credentialing txcredentialing@amerigroup.com:  Sub: RE: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  \"NASA Urgent Care is contracted as an Urgent Care, not a PCP clinic.  That means the facility bills globally (Rendering and Billing NPI are that of the clinic)  We do not have the 2nd location loaded.  Please include the phone, fax, office hours and age limits.  G#09758933\"  Sent following reply:   \"Hello,  I appreciate the reply, the requested information is as follows: Phone# 281-821-8200Fax# 718-640-2713 Office Hours: Mon-Fri: 9AM to 6PM & Sat: 9AM to 3PMAge Limits: None Please let me know if you have any other questions. Thank you!\"', NULL, NULL, '2021-06-28 10:58:01', '2021-06-28 10:58:01'),
(14963, 11056, 20702, NULL, '2021-07-24 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  The secondary location is still pending, no other information is needed.', NULL, NULL, '2021-07-16 14:14:13', '2021-07-16 14:14:13'),
(14964, 11056, 20702, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-02 09:13:48', '2021-08-02 09:13:48'),
(14965, 11056, 20702, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good morning!  Hope all is well. This is just a follow-up email regarding the secondary location. Has the secondary location been added to the Group or not yet?  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 09:40:10', '2021-08-18 09:40:10'),
(14966, 11056, 20702, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com &  keth.jackson@amerigroup.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Greetings,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Amerigroup and if the mentioned addresses were also correctly listed under them:  Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon. Thank you!   Contacted thrice on different phone numbers but no one received . Voice mails have been left out for the updates', NULL, NULL, '2021-08-27 09:36:49', '2021-08-27 09:36:49'),
(14967, 11056, 20702, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Good evening!  Hope all is well. We are still waiting to get an update regarding the secondary location. Has the secondary location been added to the Group or not yet? It has been a long time since our emails were being ignored.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great week ahead!   Try to contact through call no one had received. Voice mail has been left out  for the updates. ', NULL, NULL, '2021-09-23 17:07:31', '2021-09-23 17:07:31'),
(14968, 11056, 20702, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup  Still pending, I know this is taking a while, there is currently high volume.  I will see if I can get this moved along', NULL, NULL, '2021-10-08 09:58:34', '2021-10-08 09:58:34'),
(14969, 11056, 20702, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Rep : May D & Maya & Cristel M  Status :  Try to contact 3 or 4 contact no.s to get updates but every one transferred my call to the provider relations depart but haven\'t get a response.  The voice mail has been left out on every contact no.s  Contacted no.s :  9405312496 8004543730 (800) 454-3730  Also sent an email too.', NULL, NULL, '2021-10-18 15:35:41', '2021-10-18 15:35:41'),
(14970, 11056, 20702, NULL, '2021-11-01 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!   Also left out voice mails. Contacting no.s are on recording process', NULL, NULL, '2021-10-25 16:52:31', '2021-10-25 16:52:31'),
(14971, 11056, 20702, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Fwd: {EXTERNAL} Enrollment & Location Status Query - NASA UrgentCare - Amerigroup   Good morning!  Hope all is well with you. Could you let me know the exact time period for the credentialing process?  Because we have been waiting for this since May and we are losing our patience.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  If you have any questions or require information please let me know.  Thank you! Have a great day!', NULL, NULL, '2021-11-11 13:14:28', '2021-11-11 13:14:28'),
(14972, 11056, 20702, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to: txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818  Greetings,     Amerigroup has received your request to contract directly with our Healthplan.     We will be glad to assist.     To ensure that we have your credentialing updated, please complete the attached Letter of Intent to begin that process.        When finished completing the LOI, please email it back to me along with a copy of your W9 and group application release form.     We ask that the Letter of Interest be completed in its entirety.     **For Nurse Practitioners completing the Letter of Interest:    Your Specialty type would be considered “Family Nurse Practitioner, Geriatric Nurse Practitioner, Psychiatric Nurse Practitioner” or whichever applies to your training.     Thank you', NULL, NULL, '2021-11-19 10:22:14', '2021-11-19 10:22:14'),
(14973, 11056, 20702, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Sub:  RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope this email finds you well. Please provide me with the latest updates on the credentialing process of the provider, Segun Adeoye under the facility, Nasa Health Clinic.  Eagerly, waiting for your reply.  Thank you!', NULL, NULL, '2021-12-03 18:00:29', '2021-12-03 18:00:29'),
(14974, 11056, 20702, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope you are doing great. Please provide me with the welcome letter & effective dates for the provider & practice. Please expedite my request for processing.  Group Name	Nasa Health Clinic Tax ID	47-2682655 Group NPI	1740661453 Primary Location	985 NASA Parkway, Houston, TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a wonderful weekend!  Voice msgs have been left out.', NULL, NULL, '2021-12-14 17:46:36', '2021-12-14 17:46:36'),
(14975, 11056, 20702, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Rep: Madonna h & Jennifer P  Status:  1st one rep didn\'t find the provider in her system. Second one found the provider with only the secondary location and with only Nasa Health Clinic Tax ID. File is in the credentaling.  Ref code: 12202021', NULL, NULL, '2021-12-20 10:24:34', '2021-12-20 10:24:34'),
(14976, 11056, 20702, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Sub: RE: {EXTERNAL} Re: Delivery Status Notification (Failure) I-Q3-818   Good afternoon!  Hope all is well with you. I am still waiting to get the latest updates on the applications as well as on the facilities Nasa Health Clinic and Nasa Urgent care Inc.s\' Credentialing accomplishments yet. Please try to cope up with us through emails as your contact no.s aren\'t responded to us by anyone except the voice recorders. And we have left out so many Voice mails for the updates of the enrollment process, But haven\'t got the response yet.  Kindly respond to us as soon as possible. Please don\'t test our patience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-23 09:38:37', '2021-12-23 09:38:37'),
(14977, 19067, 20702, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group as well with Ameri Group.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Provider Name	NPI	Location Segun Adeoye	1629418025	985 NASA Parkway Houston, TX 77058-3039 Segun Adeoye	1629418025	3623 S. Main St. Suite 109, Stafford, TX 77477-5406   Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2021-12-30 14:05:31', '2021-12-30 14:05:31'),
(14978, 19067, 20702, NULL, '2022-01-15 00:00:00.000', 'In Process', 'Email sent to: TXCredentialing@amerigroup.com  Subject: Re: Enrollment Query || NASA Urgent Care || Segun Adeoye & Groups || Ameri Group ||   Hello!  This is my second reminder on the previously mentioned request.  Kindly respond promptly.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-07 23:41:20', '2022-01-07 23:41:20'),
(14979, 3046, 20703, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:59:08', '2021-03-15 09:59:08'),
(14980, 1006, 20703, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:35:22', '2021-06-07 17:35:22'),
(14981, 1006, 20703, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent f/u email @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart   \"Hello,   We are still waiting to get an update regarding the status of enrollment for the mentioned group and provider on the previous email, please get back to me as soon as possible.   Thank you!\"', NULL, NULL, '2021-06-28 09:42:28', '2021-06-28 09:42:28'),
(14982, 11056, 20703, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub  : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:54:48', '2021-07-19 16:54:48'),
(14983, 11056, 20703, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq.  Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-02 08:59:30', '2021-08-02 08:59:30'),
(14984, 11056, 20703, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 10:41:42', '2021-08-18 10:41:42'),
(14985, 11056, 20703, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Greetings Diamond,  Hope you are doing well. Kindly provide us with a welcome letter or roster soon.  If you need any further information or documents please let me know. Eagerly, waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-27 10:59:32', '2021-08-27 10:59:32'),
(14986, 11056, 20703, NULL, '2021-09-08 00:00:00.000', 'Approved', 'Email received from : pr.south@healthsmart.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  Hello, yes the provider is PAR and under addresses beloq. eff date is : 11/01/2018     Diamond Lucero |Sr. Provider Relations  HealthSmart | Network Solutions  Office: 214 574 1174 I Fax: 214 574 2368  6303 Commerce Drive | Suite 180 | Irving, TX 75039  pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-08-31 16:44:43', '2021-08-31 16:44:43'),
(14987, 3046, 20704, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:59:31', '2021-03-15 09:59:31'),
(14988, 1006, 20704, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ registrar@multiplan.com:  Sub: Enrollment Query - NASA UrgentCare - Multiplan  \"Hello,   I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:56:11', '2021-06-08 08:56:11'),
(14989, 11056, 20704, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-06-25 12:55:56', '2021-06-25 12:55:56'),
(14990, 11056, 20704, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you.', NULL, NULL, '2021-06-25 12:56:15', '2021-06-25 12:56:15'),
(14991, 11056, 20704, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-06-30 08:44:13', '2021-06-30 08:44:13'),
(14992, 11056, 20704, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. https://custservice.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040  When submitting missing information please email the information to registrarmissinginfo@multiplan.com or via fax to 781-487-8278.  Phillip B. Provider Data Management registrarmissinginfo@multiplan.com  MultiPlan 16 Crosby Drive Bedford, MA 01730', NULL, NULL, '2021-07-19 17:05:50', '2021-07-19 17:05:50'),
(14993, 11056, 20704, NULL, '2021-08-07 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-07-30 17:15:14', '2021-07-30 17:15:14'),
(14994, 11056, 20704, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Greetings,  Kindly Respond to me soon. You haven\'t replied to my last email either. I wanted to verify if the following provider and group were enrolled with Multiplan under the mentioned addresses and if so, what their effective dates were? Their information is as follows:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any documents or information, reach out to me. Please get back to me as soon as possible. Thank you!', NULL, NULL, '2021-08-18 11:09:26', '2021-08-18 11:09:26'),
(14995, 11056, 20704, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Fwd: Updated Customer Service Case 7672630  Greetings,  Hope all is well. Thank you so much for your assistance. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 11:15:17', '2021-08-18 11:15:17'),
(14996, 11056, 20704, NULL, '2021-09-04 00:00:00.000', 'In Process', 'Email  sent to : registrar@multiplan.com &  james.darmawan@multiplan.com  Sub : Enrollment Query - NASA Urgent Care - Multiplan  Good morning!  Hope all is well. Thank you so much for your assistance. Please verify the secondary location too. Is the secondary location added and listed under the TIN?  Practice Details: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address : 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address : 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Details: Provider Name : Segun Adeoye Provider NPI# : 1629418025  If you have any questions or need additional information please let me know. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-27 15:55:10', '2021-08-27 15:55:10'),
(14997, 11056, 20704, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Participating with Multiplan as received details through recorder no rep. was available. Just want to verify eff dates.', NULL, NULL, '2021-09-16 17:09:07', '2021-09-16 17:09:07'),
(14998, 11056, 20704, NULL, '2021-10-06 00:00:00.000', 'Approved', 'Rep. : SELENA P  eff dates : 06/18/2019  Status : Approved and the address is listed below on the provider.  Ref code : 7672630   Contact no. : 800-950-7040   Please see the attachment.', NULL, NULL, '2021-09-29 10:25:43', '2021-09-29 10:25:43'),
(14999, 3046, 20705, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 09:59:53', '2021-03-15 09:59:53'),
(15000, 1006, 20705, NULL, '2021-06-15 00:00:00.000', 'Approved', 'We have an ancillary contract with Molina and the Stafford address is already updated in it, please look at group tasks for location approval and executed contract. ', NULL, NULL, '2021-06-08 13:25:28', '2021-06-08 13:25:28'),
(15001, 3046, 20706, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:00:19', '2021-03-15 10:00:19'),
(15002, 1005, 20706, NULL, '2021-06-09 00:00:00.000', 'Approved', 'Medicare 1A3765', NULL, NULL, '2021-06-01 16:27:14', '2021-06-01 16:27:14'),
(15003, 3046, 20707, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:02:39', '2021-03-15 10:02:39'),
(15004, 1006, 20707, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in Superior Health task, need to allow more time. ', NULL, NULL, '2021-06-07 18:01:00', '2021-06-07 18:01:00'),
(15005, 3046, 20708, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:03:57', '2021-03-15 10:03:57'),
(15006, 1006, 20708, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Submitted enrollment query @ Provider Relations - South pr.south@healthsmart.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - HealthSmart  \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-06-07 18:04:20', '2021-06-07 18:04:20'),
(15007, 1006, 20708, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Sent a new f/u email @ credentialing@anci-care.com & ACS VIP Providers VIPproviders@anci-care.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Anci-Care   \"Hello,   I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-06-28 13:30:29', '2021-06-28 13:30:29'),
(15008, 11056, 20708, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : VIPproviders@anci-care.com   &   credentialing@anci-care.com  Sub : Enrollment & Location Status Query - NASA UrgentCare - Anci-Care  Greetings,  I hope you\'re doing well. We wanted to verify if the following group and provider were enrolled with Health Smart and if the mentioned addresses are also correctly listed under them. If not then guide me the procedure for enrollment soon.  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI# : 1821542432 Practice TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider: Provider Name: Segun Adeoye Provider NPI# : 1629418025  Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 16:28:05', '2021-07-19 16:28:05'),
(15009, 11056, 20708, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Brad,     Hi.     Please see attached for NASA Urgent Care Inc.     Email to my attention.   patti.davidson@healthsmart.com        Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-02 11:23:35', '2021-08-02 11:23:35'),
(15010, 11056, 20708, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Waiting for the Segun\'s Malpractice for the forms to be submitted. Contacted alot but haven\'t responded back yet', NULL, NULL, '2021-08-25 16:16:47', '2021-08-25 16:16:47'),
(15011, 11056, 20708, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com & Jennifer.Maligaya@healthsmart.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Sorry for the delay. Please accept my apology. Here are the forms you requested for the Ancillary contracting of Nasa Urgent Care Inc. Please find the attachment.  If further any additional information or documents are needed feel free to reach out to me. Waiting for your response.  Thank you! Have a blessed day!', NULL, NULL, '2021-09-22 14:43:41', '2021-09-22 14:43:41'),
(15012, 11056, 20708, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Thank you!  This has been sent for processing and credentialing approval.  Once approved you will receive a welcome letter and the signed agreement from our credentialing department.   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-08 08:39:29', '2021-10-08 08:39:29'),
(15013, 11056, 20708, NULL, '2021-10-22 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the following facility and provider\'s credentialing process with Anci Care.  Group Name	Nasa Urgent Care Inc. Tax ID	81-3237149 Group NPI	1821542432 Primary Location	985 NASA Parkway, Houston , TX 77058-3039 Secondary Location	3623 S. Main St. Suite 109, Stafford , TX 77477-5406 Provider Name	NPI Segun Adeoye	1629418025  Feel free to reach out to me if you have any questions or concerns.  Thank you! Have a blessed weekend!', NULL, NULL, '2021-10-15 16:54:42', '2021-10-15 16:54:42'),
(15014, 11056, 20708, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  This is in process with Credentialing for approval.     Thank you,   Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-10-22 17:06:11', '2021-10-22 17:06:11'),
(15015, 11056, 20708, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Fwd: Enrollment & Location Status Query - NASA UrgentCare - Ancillary Care Services - New Provider Agreement Packet  Good evening!  Hope this email finds you well. Any latest updates on the credentialing process. Is this approved by the credential department?  If you have any queries or concerns feel free to reach out to me.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-11-11 10:28:57', '2021-11-11 10:28:57'),
(15016, 11056, 20708, NULL, '2021-11-22 00:00:00.000', 'On Hold', 'Email received from:  Leslie.Perez@healthsmart.com  Sub : NASA HealthClinic - Anci-Care   Hello,     The approval for this facility will be on hold until I receive the information requested to complete processing.     Once you receive a copy please send me a copy.   emailed to Mr. Segun on 21, Sept,2021:  Good morning Sir!  Hope you are doing great and had a wonderful week yet.  We have not received the documents below that are necessary to complete the credentialing process yet.  DOCUMENTS IN DEMAND: 1. Business License  2. Accreditation letter.  3. CLIA  ( for both Nasa Urgent Care & Nasa Health Clinic )  Eagerly, waiting for the documents.  Take Care of yourself!  Thank you! Have a wonderful weekend!   He hasn\'t provided the documents yet.', NULL, NULL, '2021-11-15 15:11:48', '2021-11-15 15:11:48'),
(15017, 3046, 20709, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:07:55', '2021-03-15 10:07:55'),
(15018, 1006, 20709, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent enrollment query @ dhpcontracting@dchstx.org:  Sub: Enrollment Query - Nasa UrgentCare - Driscoll  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with Driscoll, if not please let me know what is required to proceed with the enrollment request, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 13:17:57', '2021-06-08 13:17:57'),
(15019, 11056, 20709, NULL, '2021-07-02 00:00:00.000', 'Not Eligible', 'Email received from : Melinda.Lopez@dchstx.org  Sub : Enrollment Query - Nasa Urgent Care - Driscoll  Hello Brad, I wanted to acknowledge receipt of your request for contract however Houston and Stafford are not in our service area.     Please note that our service areas consists of the counties listed below:     Driscoll Health Plan Service Area  Nueces Service Area:  Kenedy  Brooks  Kleberg  Jim Wells  Nueces  San Patricio  Live Oak  Bee  Refugio  Aransas Pass  Calhoun  Goliad  Bee  Karnes  Victoria     Contiguous Counties:  Atascosa  Dewitt     Hidalgo Service Area:  Cameron  Hidalgo  Willacy  Starr  Jim Hogg  Zapata  Webb  Maverick  McMullen  Duval     Feel  free to contact me should you have any questions.     Thanks', NULL, NULL, '2021-06-25 10:54:03', '2021-06-25 10:54:03'),
(15020, 3046, 20710, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:08:16', '2021-03-15 10:08:16'),
(15021, 1006, 20710, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ SWHP PROVIDER SERVICES SWHPPROVSERVICES@bswhealth.org:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Scott & White  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Scott & White and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 18:15:02', '2021-06-07 18:15:02'),
(15022, 1006, 20710, NULL, '2021-07-05 00:00:00.000', 'Approved', 'Received following confirmation email from Scott & White:   \"Good morning,  TIN 813237149 is contracted in our system eff 10/15/2017 with both locations below.  This is a facility set up, so the provider would not be listed in our system under this TIN.  Please reach out to your provider rep for further assistance and to get specifics on the plans that you are currently contracted with.  If you are unsure who your rep is, please click on the link below to review our representative map and corresponding provider rep info.   https://swhp.org/Portals/0/Files/Forms/ProviderNews/SWHP-Provider-Relations-Representative-Territory-Map.pdf  Thank you so much,  Lacey B\"', NULL, NULL, '2021-06-28 08:53:26', '2021-06-28 08:53:26'),
(15023, 3046, 20711, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:08:48', '2021-03-15 10:08:48'),
(15024, 1006, 20711, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ contracting@ghn-mci.com & providers@ghn-mci.com:  Sub: Enrollment Request - NASA UrgentCare - Galaxy Health  \"Hello,  I hope you\'re doing well, we wanted to enroll the following group and provider with Galaxy Health under the mentioned addresses, their information is as follows: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:40:18', '2021-06-07 17:40:18'),
(15025, 11056, 20711, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Email sent to : cguerue@ghn-mci.com  Sub :  CREDENTIALING DEPT - GALAXY HEALTH - NASA  Greetings,  Hope you are doing well. Enrollment form and documents are attached. please see the attachments.  Group Name: Nasa Urgent Care Inc. NPI# 1821542432  TIN# 81-3237149     Primary Address: 985 NASA Parkway, Houston, TX 77058-3039  Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406     Provider Name: Segun Adeoye  NPI# 1629418025   if you need any additional documents or details feel free to contact me.    Thank you!', NULL, NULL, '2021-06-25 09:09:48', '2021-06-25 09:09:48'),
(15026, 1006, 20711, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Sent f/u email @ Chris Guerue cguerue@ghn-mci.com:  Sub: RE: FW: CREDENTIALING DEPT - GALAXY HEALTH - NASA  \"Hello Chris,   I just wanted to verify if both the locations were listed under the group and provider, their information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Thank you!\"', NULL, NULL, '2021-07-14 17:44:15', '2021-07-14 17:44:15'),
(15027, 11056, 20711, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Email received from : cguerue@ghn-mci.com  Sub : CREDENTIALING DEPT - GALAXY HEALTH - NASA  Good Morning,  I can confirm that both locations are listed for Segun Adeoye effective 1/1/21.  Please feel free to contact me with any questions…  Thank you!  Christine Guerue Credentialing Dept cguerue@ghn-mci.com   Kindly see the attachment.', NULL, NULL, '2021-07-16 13:04:33', '2021-07-16 13:04:33'),
(15028, 3046, 20712, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:11:41', '2021-03-15 10:11:41'),
(15029, 1006, 20712, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted enrolment query @ info@usamco.com:  Sub: Enrollment Query - Nasa UrgentCare - MCO  \"Hello,  We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows: Group Name: Nasa Health Clinic NPI# 1740661453 TIN# 47-2682655  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 14:55:00', '2021-06-08 14:55:00'),
(15030, 11056, 20712, NULL, '2021-07-02 00:00:00.000', 'Initiated', 'Email sent to : info@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Hello,   We wanted to verify if the following group and provider were enrolled with MCO under the given addresses, their information is as follows:  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-06-25 12:14:02', '2021-06-25 12:14:02'),
(15031, 1006, 20712, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Sent f/u email @ info@usamco.com:  Sub: Enrollment Query - Nasa Urgent Care - MCO  \"Hello,   I hope you\'re doing good, I wanted to get an update regarding the status of my request.   Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-15 15:51:41', '2021-07-15 15:51:41'),
(15032, 11056, 20712, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from :  info@usamco.com  &   HIPOLITJ@usamco.com  Sub :  Enrollment Query - Nasa Urgent Care - MCO  Thank you , Nasa Urgent Care Inc is contracted in our network for an ancillary. Providers are automatically contracted when billing under The facility’s information, no required documents are required.  To add addt’l locations to a facility record you will need to complete our MFA. Please see attachment for  Copy of our MFA. Please complete and fwd back so we add to facility’s record and requested location/s.  If any questions please let us know  Thank You, Jackie Hipolito Provider Relations.', NULL, NULL, '2021-07-16 13:28:38', '2021-07-16 13:28:38'),
(15033, 11056, 20712, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : HIPOLITJ@usamco.com  &   info@usamco.com,  Sub : Enrollment Query - Nasa Urgent Care - MCO  Good Morning,  Hope you are doing well. Here is the filled and signed MFA for provider and group to addi additional locations to the facility . Please see the attachment.  Practice:  Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025  If you need any information or documents further, please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-28 13:47:44', '2021-07-28 13:47:44'),
(15034, 11056, 20712, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Email received from : HIPOLITJ@usamco.com  Sub : Enrollment Query - Nasa Urgent Care - MCO  Great, thank you the addt’l location site has been added effective 07/16/2021 per original update recv’d.  If any questions please contact us…a confirmation for you records.  Please see the attachment.', NULL, NULL, '2021-07-28 16:15:00', '2021-07-28 16:15:00'),
(15035, 3046, 20713, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:12:09', '2021-03-15 10:12:09'),
(15036, 1006, 20713, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Submitted address addition request via TMHP website: \" Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	Messages	Available Action   17833729	PIMS Address		6/8/2021	Provider Information Change (PIC) Form	In Progress	View	\"', NULL, NULL, '2021-06-08 09:08:30', '2021-06-08 09:08:30'),
(15037, 11056, 20713, NULL, '2021-07-06 00:00:00.000', 'Initiated', 'I have called at TMHP for inquiring about the enrollment status. She is going to fax us  a letter of Deficiency and why our application had been closed. Ref no. : 41728865000', NULL, NULL, '2021-06-28 16:42:33', '2021-06-28 16:42:33'),
(15038, 11056, 20713, NULL, '2021-08-28 00:00:00.000', 'In Process', 'Waiting for the letter of deficiency. We haven\'t received it yet', NULL, NULL, '2021-08-20 17:21:23', '2021-08-20 17:21:23'),
(15039, 11056, 20713, NULL, '2021-09-22 00:00:00.000', 'In Process', 'Portal Ticket #  Application Name  Status Update Date         Transction Type	                   Status	   17833729	     PIMS Address		6/16/2021   Provider Information Change (PIC) Form	Closed	', NULL, NULL, '2021-09-15 09:55:34', '2021-09-15 09:55:34'),
(15040, 11056, 20713, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Successfully created Provider Information Change Transaction, transaction ID: 18123085.', NULL, NULL, '2021-09-27 16:36:06', '2021-09-27 16:36:06');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(15041, 11056, 20713, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Ref code : 42435791000  Rep : Sarah C  Status:   Have to fax a form for additional location 512-514-4214.   Form has been faxed . Please see the attachment', NULL, NULL, '2021-10-08 13:20:13', '2021-10-08 13:20:13'),
(15042, 11056, 20713, NULL, '2021-10-25 00:00:00.000', 'In Process', 'The issue has been resolved and faxed them again with the corrected one.', NULL, NULL, '2021-10-18 15:39:38', '2021-10-18 15:39:38'),
(15043, 11056, 20713, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Ref code : 402556888000  Rep. : Sierra P  Status:  Request has been placed someone gonna contact us from provider relations dept. or credentialing team for the issue to be resolve  Contact no. : 800-925-9126 ', NULL, NULL, '2021-10-26 13:45:57', '2021-10-26 13:45:57'),
(15044, 11056, 20713, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Rep: Miesha   Status: Another Application has to be submitted.   Refcode: 42726745000  Applications have been faxed with a coversheet as well.', NULL, NULL, '2021-11-18 17:43:47', '2021-11-18 17:43:47'),
(15045, 11056, 20713, NULL, '2021-12-13 00:00:00.000', 'In Process', '	 Rep: Jermaine S   Status: The applications are in process. It will take around 2 weeks.   Interaction code: 42820232000', NULL, NULL, '2021-12-06 15:08:38', '2021-12-06 15:08:38'),
(15046, 11056, 20713, NULL, '2021-12-29 00:00:00.000', 'In Process', 'The Medicaid portal is under processing.', NULL, NULL, '2021-12-22 17:25:42', '2021-12-22 17:25:42'),
(15047, 3046, 20714, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:14:16', '2021-03-15 10:14:16'),
(15048, 1005, 20714, NULL, '2021-06-09 00:00:00.000', 'Approved', 'PROVIDER NAME	SEGUN P ADEOYE MD PROVIDER PTAN	P02250136 PROVIDER NPI	1629418025 EFFECTIVE DATE	06/15/2018', NULL, NULL, '2021-06-01 16:41:22', '2021-06-01 16:41:22'),
(15049, 3046, 20716, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:15:20', '2021-03-15 10:15:20'),
(15050, 1006, 20716, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment query @ Account Management - Corpus Christi AM.CorpusChristi@SuperiorHealthPlan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Superior Health and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149  Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:59:39', '2021-06-07 17:59:39'),
(15051, 1006, 20716, NULL, '2021-07-05 00:00:00.000', 'Initiated', 'Sent f/u email @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Superior Health  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the above-mentioned group and provider. Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-28 09:38:01', '2021-06-28 09:38:01'),
(15052, 1006, 20716, NULL, '2021-07-05 00:00:00.000', 'In Process', '', NULL, NULL, '2021-06-28 09:38:23', '2021-06-28 09:38:23'),
(15053, 11056, 20716, NULL, '2021-07-31 00:00:00.000', 'In Process', 'Email received from : Semetra Brazle\' via Nasa Health & Urgent Care nasa@claimsmedinc.com  Sub : Signature requested on \"ECM 546265 NASA URGENT CARE  Semetra Brazle requests your signature on ECM 546265 NASA URGENT CARE  Review and sign  Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM  Reviewing adn signing done through Adobe. Please see attachment ', NULL, NULL, '2021-07-23 17:13:24', '2021-07-23 17:13:24'),
(15054, 11056, 20716, NULL, '2021-08-09 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub  : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the below-mentioned facility and provider soon.  Practice: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  Provider: Provider Name: Segun Adeoye NPI# 1629418025 Please get back to me as soon as you\'re able to. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-02 08:42:35', '2021-08-02 08:42:35'),
(15055, 11056, 20716, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good morning!  Hope all is well. Are the Primary & secondary locations also listed & added under the practice Tax I.D?  Practice Details: Practice Name: Nasa Urgent Care Inc. Practice NPI # : 1821542432 Practice TIN # : 81-3237149 Primary Address: 985 NASA Parkway, Houston , TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford , TX 77477-5406  If you have any questions or queries please let me know.   Thank you! Have a great day! ', NULL, NULL, '2021-08-18 09:52:57', '2021-08-18 09:52:57'),
(15056, 11056, 20716, NULL, '2021-09-04 00:00:00.000', 'Approved', 'Approval Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment & Location Status Query - NASA Urgent Care - Superior Health  Good afternoon Ahmed  My apologies for the delay in response  Here is the information you requested Here is the locations under the Group TID  For the following Provider  eff date is : 06/01/2019', NULL, NULL, '2021-08-27 16:47:59', '2021-08-27 16:47:59'),
(15057, 3046, 20717, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:15:50', '2021-03-15 10:15:50'),
(15058, 1006, 20717, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent following enrollment query @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Query - NASA UrgentCare - TRPN  \"Hello,  I hope you\'re doing well, we wanted to find out if the following provider and group was enrolled with TRPN, the information is as follows:  Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-08 08:49:05', '2021-06-08 08:49:05'),
(15059, 1006, 20717, NULL, '2021-06-25 00:00:00.000', 'In Process', 'We received the following reply from trpndataentry@trpnppo.com:  Sub; RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hi,  The group is enrolled, effective date 11/30/2016,  Could you send me the enrollment information for Adeoye, please?  Thank you,  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\"  Sent reply:   \"Hello Carlos,   I appreciate the reply, please let me know what enrollment information is required for Segun Adeoye?  Thank you!\"', NULL, NULL, '2021-06-18 12:51:52', '2021-06-18 12:51:52'),
(15060, 1006, 20717, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following email from :  Sub: RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hi Brad,  I have attach you the Provider Update Form,  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\"  The form was filled out and sent back to Carlos. Attached in the group task for reference. ', NULL, NULL, '2021-06-21 11:55:08', '2021-06-21 11:55:08'),
(15061, 1006, 20717, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com via TRPN portal (https://web1.zixmail.net/s/compose?b=trpn):  Sub: RE: Enrollment Query - NASA UrgentCare - TRPN  \"Hello Carlos,  I hope you\'re doing well, I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:   Group Name: Nasa Urgent Care Inc. NPI# 1821542432 TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-07-08 12:26:18', '2021-07-08 12:26:18'),
(15062, 11056, 20717, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub :  Enrollment Query - NASA UrgentCare - TRPN  Greetings,  I hope you\'re doing well. I wanted to verify what the status of enrollment is for the following group and provider and if the mentioned addresses are listed under both:  Practice: Group Name: Nasa Urgent Care Inc. NPI# : 1821542432 TIN# : 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039 Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406  Provider:  Provider Name: Segun Adeoye NPI# 1629418025  Please get back to me as soon as you\'re able to. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 05:37:47', '2021-07-20 05:37:47'),
(15063, 11056, 20717, NULL, '2021-07-31 00:00:00.000', 'Approved', 'Email received from : trpndataentry@trpnppo.com  Sub  : Enrollment Query - NASA UrgentCare - TRPN  Hi,     This request is completed,     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  Please see attachment.', NULL, NULL, '2021-07-23 16:30:18', '2021-07-23 16:30:18'),
(15064, 3046, 20718, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:16:15', '2021-03-15 10:16:15'),
(15065, 1006, 20718, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment request @ Yvonne Wyatt ywyatt@humana.com:  Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Hello Yvonne,  I hope you\'re doing well, we wanted to verify if the following group and provider were enrolled with Tricare and if the mentioned addresses are also correctly listed under them: Group Name: Nasa Urgent Care Inc. NPI# 1821542432TIN# 81-3237149 Primary Address: 985 NASA Parkway, Houston, TX 77058-3039Secondary Address: 3623 S. Main St. Suite 109, Stafford, TX 77477-5406 Provider Name: Segun AdeoyeNPI# 1629418025 Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-07 17:46:07', '2021-06-07 17:46:07'),
(15066, 1006, 20718, NULL, '2021-07-05 00:00:00.000', 'Approved', 'We received the following response from Tricare :Yvonne Wyatt ywyatt@humana.com   Sub: Enrollment & Location Status Query - NASA UrgentCare - Tricare  \"Good Morning Brad,  We show this provider as network. You can check network status by creating a log in on the Provider Portal using this link Provider Self-Service (humana-military.com)\"', NULL, NULL, '2021-06-28 09:22:56', '2021-06-28 09:22:56'),
(15067, 3040, 20719, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:34:48', '2021-03-15 10:34:48'),
(15068, 3040, 20719, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group has an ancillary contract.   Please see attachment. ', NULL, NULL, '2021-05-07 08:48:01', '2021-05-07 08:48:01'),
(15069, 3040, 20720, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:35:18', '2021-03-15 10:35:18'),
(15070, 3040, 20720, NULL, '2021-05-14 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-05-07 08:48:41', '2021-05-07 08:48:41'),
(15071, 3040, 20720, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-05-07 08:48:55', '2021-05-07 08:48:55'),
(15072, 3046, 20721, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:36:43', '2021-03-15 10:36:43'),
(15073, 3040, 20721, NULL, '2021-04-05 00:00:00.000', 'Approved', 'Group contracted with BCBS.   Please see attachment. ', NULL, NULL, '2021-03-29 10:47:45', '2021-03-29 10:47:45'),
(15074, 3040, 20722, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:36:50', '2021-03-15 10:36:50'),
(15075, 3040, 20722, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-05-07 08:48:49', '2021-05-07 08:48:49'),
(15076, 3040, 20723, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:37:11', '2021-03-15 10:37:11'),
(15077, 3040, 20723, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-05-07 08:49:02', '2021-05-07 08:49:02'),
(15078, 3040, 20724, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:37:35', '2021-03-15 10:37:35'),
(15079, 3040, 20724, NULL, '2021-05-14 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers.   Please see group task. ', NULL, NULL, '2021-05-07 08:49:07', '2021-05-07 08:49:07'),
(15080, 3046, 20725, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:39:39', '2021-03-15 10:39:39'),
(15081, 1005, 20725, NULL, '2021-06-12 00:00:00.000', 'Not Eligible', '1 provider practice doesn\'t meet Superior\'s In-Network group eligibility criteria.', NULL, NULL, '2021-06-04 14:42:46', '2021-06-04 14:42:46'),
(15082, 3040, 20726, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:41:15', '2021-03-15 10:41:15'),
(15083, 3040, 20726, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enroll Group || Columbus Urgent Care PA || Ambetter ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group in Ambetter in our group Columbus Urgent Care PA under below locations. Please advise.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 16:00:42', '2021-05-20 16:00:42'),
(15084, 3040, 20726, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:53:06', '2021-06-09 08:53:06'),
(15085, 3040, 20726, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:11', '2021-06-28 11:05:11'),
(15086, 3040, 20726, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:04:01', '2021-07-15 15:04:01'),
(15087, 11056, 20726, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:21:34', '2021-08-05 14:21:34'),
(15088, 3040, 20726, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:42', '2021-08-27 16:18:42'),
(15089, 3040, 20726, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:31', '2021-08-27 16:23:31'),
(15090, 10057, 20726, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:21:41', '2021-10-11 16:21:41'),
(15091, 10057, 20726, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Dear Team,  Hope this email finds you well. Could you please provide me the latest update on enrollment status for the below mentioned provider and group.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Molly Joseph	1396380077  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-11-17 16:14:43', '2021-11-17 16:14:43'),
(15092, 10057, 20726, NULL, '2021-12-07 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  Provider 1396380077- is in credentialing process no effective date at this time.  Thanks, YA Account Management Region 3', NULL, NULL, '2021-11-30 10:34:46', '2021-11-30 10:34:46'),
(15093, 10057, 20726, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Thank you for the update.  Regards,', NULL, NULL, '2021-12-06 15:49:50', '2021-12-06 15:49:50'),
(15094, 10057, 20726, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-12-14 09:36:11', '2021-12-14 09:36:11'),
(15095, 10057, 20726, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Received From : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,  Provider 1396380077- is currently in make par status with an effective date of 1/1/21.  Thanks Account Management', NULL, NULL, '2021-12-20 17:43:51', '2021-12-20 17:43:51'),
(15096, 10057, 20726, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings!  Thank you for providing me with the update. When can I get the welcome packet?  Regards,', NULL, NULL, '2021-12-27 10:43:52', '2021-12-27 10:43:52'),
(15097, 19067, 20726, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||   Hello!  Hope you are doing well.  I would like to know the enrollment status of the following Provider and Group with Ambetter.  If the Provider is Enrolled then provide us with Effective date and Welcome kit. It would be very helpful for us.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215 Provider Name	NPI Joseph, Molly	1396380077   Eagerly waiting for your reply.  Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 13:59:02', '2022-01-04 13:59:02'),
(15098, 20067, 20726, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Molly Joseph & Group || Superior Health ||  Good afternoon!  Hope this email finds you in good spirits. Any update on the below-mentioned provider?  Kindly respond promptly. Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-20 15:05:13', '2022-01-20 15:05:13'),
(15099, 20067, 20726, NULL, '2022-02-03 00:00:00.000', 'In Process', 'Email sent to:AM.Austin@superiorhealthplan.com  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group || Superior Health ||  Good Morning!  Hope this email finds you well. I would like to know the enrollment status of the Group mentioned below.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus, TX 78934-2215  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-27 09:39:11', '2022-01-27 09:39:11'),
(15100, 20067, 20726, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Email received from:  Sub: Re: Enrollment Status || Columbus Urgent Care PA || Group || Superior Health ||   Group Status effective 7/1/2021     Group Name  Columbus Urgent Care  Tax ID  47-1914151  Group NPI  1215330501  Practice Address  926 Walnut St, Columbus, TX 78934-2215           NPI  TIN  HAT CODE  EFFECTIVE DATE  END DATE  PRODUCT  STATUS  1215330501  471914151  SPECIALTY CARE PROVIDER  07/01/2021  12/31/9999  STAR PLUS  PAR     Thanks,     YA  Account Management  Region 3', NULL, NULL, '2022-02-02 11:44:39', '2022-02-02 11:44:39'),
(15101, 3040, 20727, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:41:55', '2021-03-15 10:41:55'),
(15102, 3040, 20727, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Request submitted online.   Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon.', NULL, NULL, '2021-05-19 15:37:59', '2021-05-19 15:37:59'),
(15103, 3040, 20727, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Provider is participating with Ambetter. Please see attachment', NULL, NULL, '2021-05-20 12:50:32', '2021-05-20 12:50:32'),
(15104, 3040, 20728, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:42:13', '2021-03-15 10:42:13'),
(15105, 3040, 20728, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Provider participating with Ambetter.   Please see attachment', NULL, NULL, '2021-05-20 13:08:55', '2021-05-20 13:08:55'),
(15106, 3046, 20729, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:42:28', '2021-03-15 10:42:28'),
(15107, 1005, 20729, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Eff: 3/1/2012 Provider ID: 9126809 S9083 for $150', NULL, NULL, '2021-06-04 14:23:18', '2021-06-04 14:23:18'),
(15108, 3040, 20730, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:42:37', '2021-03-15 10:42:37'),
(15109, 3040, 20730, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:38:27', '2021-05-20 13:38:27'),
(15110, 3040, 20730, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:59', '2021-06-09 08:52:59'),
(15111, 3040, 20730, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:01', '2021-06-28 11:05:01'),
(15112, 3040, 20730, NULL, '2021-07-22 00:00:00.000', 'Approved', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3 Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:00:41', '2021-07-15 15:00:41'),
(15113, 3046, 20731, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:01', '2021-03-15 10:43:01'),
(15114, 1005, 20731, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Eff: 1/1/2016 Provider ID: 7442412 S9083 for $150', NULL, NULL, '2021-06-04 14:22:54', '2021-06-04 14:22:54'),
(15115, 3040, 20732, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:15', '2021-03-15 10:43:15'),
(15116, 3040, 20732, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Provider participating with Ambetter.   Ref: I-56037586 ', NULL, NULL, '2021-05-20 13:10:26', '2021-05-20 13:10:26'),
(15117, 3040, 20733, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:38', '2021-03-15 10:43:38'),
(15118, 3040, 20733, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:38:31', '2021-05-20 13:38:31'),
(15119, 3040, 20733, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:53', '2021-06-09 08:52:53'),
(15120, 3040, 20733, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:14', '2021-06-28 11:05:14'),
(15121, 3040, 20733, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:04:00', '2021-07-15 15:04:00'),
(15122, 11056, 20733, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:21:20', '2021-08-05 14:21:20'),
(15123, 3040, 20733, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:41', '2021-08-27 16:18:41'),
(15124, 3040, 20733, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:30', '2021-08-27 16:23:30'),
(15125, 10057, 20733, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:21:29', '2021-10-11 16:21:29'),
(15126, 10057, 20733, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : AM.Austin@superiorhealthplan.com  Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good afternoon ECM Team,  Provider is requesting welcome letter for providers listed below.  Group Name Columbus Urgent Care  Tax ID 47-1914151  Group NPI 1215330501  Practice Address 926 Walnut St, Columbus , TX 78934-2215  Provider Name NPI  Chennemkara, Mini Philip 1841755956 - effective 8/1/2021  Abraham, Glory 1194206490- effective 7/1/2021  Stephen, Ani 1588959118 effective 7/1/2021  PAUL, SIGI 1033623616- effective 6/1/2021  Jacob, Jaya 1194336149- effective 10/1/2021  Abraham, Jeena 1467901587- effective 7/1/2021  Thomas, Cini 1134777238- effective 7/1/2021  Thanks,  YA Account Management Region 3', NULL, NULL, '2021-11-17 15:46:29', '2021-11-17 15:46:29'),
(15127, 3046, 20734, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:48', '2021-03-15 10:43:48'),
(15128, 1005, 20734, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Per Procedure contract. ', NULL, NULL, '2021-06-04 14:37:15', '2021-06-04 14:37:15'),
(15129, 3046, 20735, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:54', '2021-03-15 10:43:54'),
(15130, 1005, 20735, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Per Procedure contract. ', NULL, NULL, '2021-06-04 14:37:08', '2021-06-04 14:37:08'),
(15131, 3040, 20736, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:43:58', '2021-03-15 10:43:58'),
(15132, 3040, 20736, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Provider participating with Ambetter.   Please see attachment ', NULL, NULL, '2021-05-20 13:12:21', '2021-05-20 13:12:21'),
(15133, 3040, 20737, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:44:18', '2021-03-15 10:44:18'),
(15134, 3040, 20737, NULL, '2021-05-27 00:00:00.000', 'Approved', 'Provider participating with Ambetter.   Please see attachment', NULL, NULL, '2021-05-20 13:13:43', '2021-05-20 13:13:43'),
(15135, 3040, 20738, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:44:36', '2021-03-15 10:44:36'),
(15136, 3040, 20738, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:38:35', '2021-05-20 13:38:35');
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
(15137, 3040, 20738, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:47', '2021-06-09 08:52:47'),
(15138, 3040, 20738, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:08', '2021-06-28 11:05:08'),
(15139, 3040, 20738, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:04:00', '2021-07-15 15:04:00'),
(15140, 11056, 20738, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:20:47', '2021-08-05 14:20:47'),
(15141, 3040, 20738, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:41', '2021-08-27 16:18:41'),
(15142, 3040, 20738, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:29', '2021-08-27 16:23:29'),
(15143, 10057, 20738, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:20:23', '2021-10-11 16:20:23'),
(15144, 10057, 20738, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : AM.Austin@superiorhealthplan.com  Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good afternoon ECM Team,  Provider is requesting welcome letter for providers listed below.  Group Name Columbus Urgent Care  Tax ID 47-1914151  Group NPI 1215330501  Practice Address 926 Walnut St, Columbus , TX 78934-2215  Provider Name NPI  Chennemkara, Mini Philip 1841755956 - effective 8/1/2021  Abraham, Glory 1194206490- effective 7/1/2021  Stephen, Ani 1588959118 effective 7/1/2021  PAUL, SIGI 1033623616- effective 6/1/2021  Jacob, Jaya 1194336149- effective 10/1/2021  Abraham, Jeena 1467901587- effective 7/1/2021  Thomas, Cini 1134777238- effective 7/1/2021  Thanks,  YA Account Management Region 3', NULL, NULL, '2021-11-17 15:49:05', '2021-11-17 15:49:05'),
(15145, 3040, 20739, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:02', '2021-03-15 10:45:02'),
(15146, 3040, 20739, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:38:40', '2021-05-20 13:38:40'),
(15147, 3040, 20739, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:40', '2021-06-09 08:52:40'),
(15148, 3040, 20739, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:23', '2021-06-28 11:05:23'),
(15149, 3040, 20739, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:03:59', '2021-07-15 15:03:59'),
(15150, 11056, 20739, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:20:39', '2021-08-05 14:20:39'),
(15151, 3040, 20739, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:40', '2021-08-27 16:18:40'),
(15152, 3040, 20739, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:28', '2021-08-27 16:23:28'),
(15153, 10057, 20739, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:20:12', '2021-10-11 16:20:12'),
(15154, 10057, 20739, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : AM.Austin@superiorhealthplan.com  Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good afternoon ECM Team,  Provider is requesting welcome letter for providers listed below.  Group Name Columbus Urgent Care  Tax ID 47-1914151  Group NPI 1215330501  Practice Address 926 Walnut St, Columbus , TX 78934-2215  Provider Name NPI  Chennemkara, Mini Philip 1841755956 - effective 8/1/2021  Abraham, Glory 1194206490- effective 7/1/2021  Stephen, Ani 1588959118 effective 7/1/2021  PAUL, SIGI 1033623616- effective 6/1/2021  Jacob, Jaya 1194336149- effective 10/1/2021  Abraham, Jeena 1467901587- effective 7/1/2021  Thomas, Cini 1134777238- effective 7/1/2021  Thanks,  YA Account Management Region 3', NULL, NULL, '2021-11-17 15:47:18', '2021-11-17 15:47:18'),
(15155, 3046, 20740, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:08', '2021-03-15 10:45:08'),
(15156, 1005, 20740, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Approved. Per Procedure contract.', NULL, NULL, '2021-06-04 14:38:33', '2021-06-04 14:38:33'),
(15157, 3046, 20741, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:10', '2021-03-15 10:45:10'),
(15158, 1005, 20741, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Group is only added as a location. BCBS doesn\'t enroll 1 provider groups.', NULL, NULL, '2021-06-04 14:38:08', '2021-06-04 14:38:08'),
(15159, 3040, 20742, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:19', '2021-03-15 10:45:19'),
(15160, 3040, 20742, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:38:52', '2021-05-20 13:38:52'),
(15161, 3040, 20742, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:34', '2021-06-09 08:52:34'),
(15162, 3040, 20742, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:18', '2021-06-28 11:05:18'),
(15163, 3040, 20742, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:03:59', '2021-07-15 15:03:59'),
(15164, 11056, 20742, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:20:29', '2021-08-05 14:20:29'),
(15165, 3040, 20742, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:38', '2021-08-27 16:18:38'),
(15166, 3040, 20742, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:28', '2021-08-27 16:23:28'),
(15167, 10057, 20742, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:20:00', '2021-10-11 16:20:00'),
(15168, 10057, 20742, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : AM.Austin@superiorhealthplan.com  Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good afternoon ECM Team,  Provider is requesting welcome letter for providers listed below.  Group Name Columbus Urgent Care  Tax ID 47-1914151  Group NPI 1215330501  Practice Address 926 Walnut St, Columbus , TX 78934-2215  Provider Name NPI  Chennemkara, Mini Philip 1841755956 - effective 8/1/2021  Abraham, Glory 1194206490- effective 7/1/2021  Stephen, Ani 1588959118 effective 7/1/2021  PAUL, SIGI 1033623616- effective 6/1/2021  Jacob, Jaya 1194336149- effective 10/1/2021  Abraham, Jeena 1467901587- effective 7/1/2021  Thomas, Cini 1134777238- effective 7/1/2021  Thanks,  YA Account Management Region 3', NULL, NULL, '2021-11-17 15:48:45', '2021-11-17 15:48:45'),
(15169, 3040, 20743, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:33', '2021-03-15 10:45:33'),
(15170, 1005, 20743, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:45:03', '2021-06-01 12:45:03'),
(15171, 3040, 20744, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:47', '2021-03-15 10:45:47'),
(15172, 3040, 20744, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group & providers in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 13:39:16', '2021-05-20 13:39:16'),
(15173, 3040, 20744, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:28', '2021-06-09 08:52:28'),
(15174, 3040, 20744, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:05', '2021-06-28 11:05:05'),
(15175, 3040, 20744, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:03:58', '2021-07-15 15:03:58'),
(15176, 11056, 20744, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:20:18', '2021-08-05 14:20:18'),
(15177, 3040, 20744, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: SHP.NetworkDevelopment@superiorhealthplan.com  Subject:Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider Name: Chennemkara, Mini Provider NPI# 1841755956  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! ', NULL, NULL, '2021-08-27 16:18:37', '2021-08-27 16:18:37'),
(15178, 3040, 20744, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:23:26', '2021-08-27 16:23:26'),
(15179, 10057, 20744, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:19:43', '2021-10-11 16:19:43'),
(15180, 10057, 20744, NULL, '2021-11-24 00:00:00.000', 'Approved', 'Email Received From : AM.Austin@superiorhealthplan.com  Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good afternoon ECM Team,  Provider is requesting welcome letter for providers listed below.  Group Name Columbus Urgent Care  Tax ID 47-1914151  Group NPI 1215330501  Practice Address 926 Walnut St, Columbus , TX 78934-2215  Provider Name NPI  Chennemkara, Mini Philip 1841755956 - effective 8/1/2021  Abraham, Glory 1194206490- effective 7/1/2021  Stephen, Ani 1588959118 effective 7/1/2021  PAUL, SIGI 1033623616- effective 6/1/2021  Jacob, Jaya 1194336149- effective 10/1/2021  Abraham, Jeena 1467901587- effective 7/1/2021  Thomas, Cini 1134777238- effective 7/1/2021  Thanks,  YA Account Management Region 3', NULL, NULL, '2021-11-17 15:47:38', '2021-11-17 15:47:38'),
(15181, 3046, 20745, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:45:59', '2021-03-15 10:45:59'),
(15182, 1005, 20745, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Per procedure contract. No S9083.', NULL, NULL, '2021-06-04 14:40:01', '2021-06-04 14:40:01'),
(15183, 3046, 20746, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:46:01', '2021-03-15 10:46:01'),
(15184, 1005, 20746, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Approved.', NULL, NULL, '2021-06-04 14:39:40', '2021-06-04 14:39:40'),
(15185, 3040, 20747, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:46:02', '2021-03-15 10:46:02'),
(15186, 3040, 20747, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Request submitted online.   Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-05-20 13:45:54', '2021-05-20 13:45:54'),
(15187, 3040, 20747, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:24', '2021-06-09 08:52:24'),
(15188, 3040, 20747, NULL, '2021-07-05 00:00:00.000', 'Approved', 'I spoke with (April) Ambetter representative and she said the provider is in-network with Ambetter. Effective date: 06/01/2021. Confirmation from provider directory attached for your reference. ', NULL, NULL, '2021-06-28 10:59:52', '2021-06-28 10:59:52'),
(15189, 3040, 20748, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:46:18', '2021-03-15 10:46:18'),
(15190, 3040, 20748, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Request submitted online.   Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-05-20 13:48:14', '2021-05-20 13:48:14'),
(15191, 3040, 20748, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:17', '2021-06-09 08:52:17'),
(15192, 3040, 20748, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:26', '2021-06-28 11:05:26'),
(15193, 3040, 20748, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:03:57', '2021-07-15 15:03:57');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(15194, 11056, 20748, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:16:27', '2021-08-05 14:16:27'),
(15195, 11056, 20748, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:20:06', '2021-08-05 14:20:06'),
(15196, 3040, 20748, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:24:15', '2021-08-27 16:24:15'),
(15197, 10057, 20748, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:19:31', '2021-10-11 16:19:31'),
(15198, 10057, 20748, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : Credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831', NULL, NULL, '2021-11-11 14:28:33', '2021-11-11 14:28:33'),
(15199, 3040, 20749, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:46:30', '2021-03-15 10:46:30'),
(15200, 3040, 20749, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Request submitted online.   Thank You Thank you for your Ambetter network participation request! We have received your inquiry. Please allow 7-10 business days for our reply.', NULL, NULL, '2021-05-20 13:50:30', '2021-05-20 13:50:30'),
(15201, 3040, 20749, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in our in Ambetter in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 6: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 7: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 08:52:11', '2021-06-09 08:52:11'),
(15202, 3040, 20749, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-28 11:05:29', '2021-06-28 11:05:29'),
(15203, 3040, 20749, NULL, '2021-07-22 00:00:00.000', 'In Process', 'Email rcvd from: AM.Austin@superiorhealthplan.com  Subject: RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Good afternoon,  Please see status listed below for each provider.  Thanks,  YA Account Management Region 3   Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537- Effective 7/1/2021  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956- Make par status  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490- make par status  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587- make par status  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118- make par status  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238- make par status  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149- in credentialing status  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616- in credentialing status   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-07-15 15:03:56', '2021-07-15 15:03:56'),
(15204, 11056, 20749, NULL, '2021-08-13 00:00:00.000', 'In Process', 'Email sent to : AM.Austin@superiorhealthplan.com  Sub : RE: Enrollment Status || Columbus Urgent Care PA || Providers || Ambetter||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Ambetter for our group Columbus Urgent Care PA under the below location.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID# : 47-1914151 Practice NPI# : 1215330501 Practice Address : 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 3: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: PAUL, SIGI Provider NPI# 1033623616   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 14:15:43', '2021-08-05 14:15:43'),
(15205, 3040, 20749, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Austin@superiorhealthplan.com  Subject: Re: Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Superior Health plan in our group Columbus Urgent Care PA under the below location.    Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus, TX 78934-2215  Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name:Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 7: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.    Thank you ', NULL, NULL, '2021-08-27 16:24:11', '2021-08-27 16:24:11'),
(15206, 10057, 20749, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email Sent To : AM.Austin@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good Evening,  Hope you are doing well. I\'m writing this email to check the updated enrollment status for the below mentioned providers in Superior Health Plan in our group Columbus Urgent Care PA under the below location.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thanks & Regards,', NULL, NULL, '2021-10-11 16:19:17', '2021-10-11 16:19:17'),
(15207, 10057, 20749, NULL, '2021-11-18 00:00:00.000', 'Approved', 'Email Received From : Credentialing@superiorhealthplan.com  Sub : Enrollment Status || Columbus Urgent Care PA || Providers || Superior Health ||  Good morning,  I am able to locate the following information per the status request below for the providers:  1396380077-I currently show the file is in progress and has not been completed at this time, the credentialing specialist will contact you directly if there is any missing/incomplete information.  1033623616-The providers credentialing is complete, the effective date is 09/01/2021 and the re-credential date is 08/31/2024.  1194336149-The providers credentialing is complete, the effective date is 10/01/2021 and the re-credential date is 08/31/2024.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831', NULL, NULL, '2021-11-11 14:29:48', '2021-11-11 14:29:48'),
(15208, 3040, 20750, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:47:37', '2021-03-15 10:47:37'),
(15209, 3040, 20750, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:14:49', '2021-05-20 14:14:49'),
(15210, 3040, 20751, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:47:52', '2021-03-15 10:47:52'),
(15211, 3040, 20751, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:14:53', '2021-05-20 14:14:53'),
(15212, 3040, 20752, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:10', '2021-03-15 10:48:10'),
(15213, 3040, 20752, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:14:58', '2021-05-20 14:14:58'),
(15214, 3046, 20753, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:13', '2021-03-15 10:48:13'),
(15215, 1005, 20753, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:40:31', '2021-06-04 14:40:31'),
(15216, 3046, 20754, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:15', '2021-03-15 10:48:15'),
(15217, 1005, 20754, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:40:22', '2021-06-04 14:40:22'),
(15218, 3040, 20755, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:35', '2021-03-15 10:48:35'),
(15219, 3040, 20755, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:03', '2021-05-20 14:15:03'),
(15220, 3046, 20756, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:41', '2021-03-15 10:48:41'),
(15221, 1005, 20756, NULL, '2021-06-12 00:00:00.000', 'Not Eligible', 'Not enrolling this specialty.', NULL, NULL, '2021-06-04 14:41:15', '2021-06-04 14:41:15'),
(15222, 3046, 20757, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:48:46', '2021-03-15 10:48:46'),
(15223, 1005, 20757, NULL, '2021-06-12 00:00:00.000', 'Not Eligible', 'Not enrolling this specialty.', NULL, NULL, '2021-06-04 14:41:06', '2021-06-04 14:41:06'),
(15224, 3046, 20758, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:07', '2021-03-15 10:49:07'),
(15225, 1005, 20758, NULL, '2021-06-12 00:00:00.000', 'Not Eligible', 'Doesn\'t required as per the Client.', NULL, NULL, '2021-06-04 14:41:52', '2021-06-04 14:41:52'),
(15226, 3040, 20759, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:08', '2021-03-15 10:49:08'),
(15227, 3040, 20759, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:08', '2021-05-20 14:15:08'),
(15228, 3046, 20760, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:14', '2021-03-15 10:49:14'),
(15229, 1005, 20760, NULL, '2021-06-12 00:00:00.000', 'Not Eligible', 'Doesn\'t required as per the Client.', NULL, NULL, '2021-06-04 14:41:46', '2021-06-04 14:41:46'),
(15230, 3040, 20761, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:24', '2021-03-15 10:49:24'),
(15231, 3040, 20761, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:13', '2021-05-20 14:15:13'),
(15232, 3046, 20762, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:35', '2021-03-15 10:49:35'),
(15233, 1005, 20762, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:50:42', '2021-06-04 14:50:42'),
(15234, 3046, 20763, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:41', '2021-03-15 10:49:41'),
(15235, 1005, 20763, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:50:38', '2021-06-04 14:50:38'),
(15236, 3040, 20764, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:43', '2021-03-15 10:49:43'),
(15237, 3040, 20764, NULL, '2021-05-27 00:00:00.000', 'In Process', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:18', '2021-05-20 14:15:18'),
(15238, 3040, 20764, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:30', '2021-05-20 14:15:30'),
(15239, 3040, 20765, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:49:58', '2021-03-15 10:49:58'),
(15240, 3040, 20765, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:39', '2021-05-20 14:15:39'),
(15241, 3046, 20766, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:14', '2021-03-15 10:50:14'),
(15242, 1005, 20766, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:49:57', '2021-06-04 14:49:57'),
(15243, 3040, 20767, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:14', '2021-03-15 10:50:14'),
(15244, 1005, 20767, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:47:08', '2021-06-01 12:47:08'),
(15245, 1005, 20767, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Provider is no longer working for this Practice. Eff from 12/15/2020', NULL, NULL, '2021-06-01 12:55:56', '2021-06-01 12:55:56'),
(15246, 3046, 20768, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:16', '2021-03-15 10:50:16'),
(15247, 1005, 20768, NULL, '2021-06-12 00:00:00.000', 'Approved', '', NULL, NULL, '2021-06-04 14:50:02', '2021-06-04 14:50:02'),
(15248, 3040, 20769, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:28', '2021-03-15 10:50:28'),
(15249, 3040, 20769, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:50', '2021-05-20 14:15:50'),
(15250, 3046, 20770, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:40', '2021-03-15 10:50:40'),
(15251, 1005, 20770, NULL, '2021-06-12 00:00:00.000', 'Approved', '1/1/2015 Commercial 1/1/2015 Medicaid 3/26/2010 Medicare', NULL, NULL, '2021-06-04 14:51:50', '2021-06-04 14:51:50'),
(15252, 3040, 20771, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:41', '2021-03-15 10:50:41'),
(15253, 3040, 20771, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:15:56', '2021-05-20 14:15:56'),
(15254, 3046, 20772, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:42', '2021-03-15 10:50:42'),
(15255, 1005, 20772, NULL, '2021-06-12 00:00:00.000', 'Approved', 'Commercial 1/1/2015 Medicaid 12/16/2011 Medicare 11/1/2011', NULL, NULL, '2021-06-04 14:51:19', '2021-06-04 14:51:19'),
(15256, 3040, 20773, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:50:54', '2021-03-15 10:50:54'),
(15257, 3040, 20773, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:16:00', '2021-05-20 14:16:00'),
(15258, 3040, 20774, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:51:06', '2021-03-15 10:51:06'),
(15259, 3040, 20774, NULL, '2021-05-27 00:00:00.000', 'Approved', 'From: Hughes, Jason T. -jason.hughes@amerigroup.com Sub: RE: {EXTERNAL} Provider Credentialing Status Request  Columbus UC is contracted as a facility, meaning that the facility only needs to be in network.  Eff date 03/26/2020', NULL, NULL, '2021-05-20 14:16:05', '2021-05-20 14:16:05'),
(15260, 3040, 20777, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:53:12', '2021-03-15 10:53:12'),
(15261, 3040, 20777, NULL, '2021-05-17 00:00:00.000', 'New/Not Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:30:34', '2021-05-10 07:30:34'),
(15262, 1006, 20777, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:24', '2021-06-01 11:18:24'),
(15263, 3040, 20777, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. Please see attachment. ', NULL, NULL, '2021-06-18 16:56:28', '2021-06-18 16:56:28'),
(15264, 3040, 20778, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:53:34', '2021-03-15 10:53:34'),
(15265, 3040, 20778, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:30:38', '2021-05-10 07:30:38'),
(15266, 1006, 20778, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:34', '2021-06-01 11:19:34'),
(15267, 3040, 20778, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:40', '2021-06-18 17:00:40'),
(15268, 3040, 20779, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:54:01', '2021-03-15 10:54:01'),
(15269, 3040, 20779, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:30:43', '2021-05-10 07:30:43'),
(15270, 1006, 20779, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:20', '2021-06-01 11:19:20'),
(15271, 3040, 20779, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:39', '2021-06-18 17:00:39'),
(15272, 3040, 20780, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:54:23', '2021-03-15 10:54:23'),
(15273, 3040, 20780, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:30:48', '2021-05-10 07:30:48'),
(15274, 1006, 20780, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:47', '2021-06-01 11:18:47'),
(15275, 3040, 20780, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:39', '2021-06-18 17:00:39'),
(15276, 3040, 20781, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:54:39', '2021-03-15 10:54:39'),
(15277, 3040, 20781, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:30:53', '2021-05-10 07:30:53'),
(15278, 1006, 20781, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:19:15', '2021-06-01 11:19:15'),
(15279, 3040, 20781, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:38', '2021-06-18 17:00:38'),
(15280, 3040, 20782, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:54:54', '2021-03-15 10:54:54'),
(15281, 3040, 20782, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:11', '2021-05-10 07:31:11'),
(15282, 1006, 20782, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer Maligaya Jennifer.Maligaya@healthsmart.com:  Sub: Enrollment Status - CUCC - Anci-Care  \"Hello Jennifer, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following group and providers with Anci-Care:  Group Name: Columbus Urgent Care PA NPI# 1215330501TIN# 47-1914151 Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-06-01 11:18:51', '2021-06-01 11:18:51'),
(15283, 3040, 20782, NULL, '2021-06-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. ', NULL, NULL, '2021-06-18 17:00:38', '2021-06-18 17:00:38'),
(15284, 3040, 20783, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-15 10:55:35', '2021-03-15 10:55:35'),
(15285, 3040, 20783, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || Group & Providers || Anci Care ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Ancicare under the below location.  Practice Details: Practice Name: Columbus Urgent Care PA  Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: Rauf., Abdur Provider NPI# 1497726202   Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4: Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 5: Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 7: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 8: Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 9: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 10: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 11: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12: Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 13: Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 14: Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 15: Provider Name: PAUL, SIGI Provider NPI# 1033623616  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-10 07:31:16', '2021-05-10 07:31:16');
