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
(21143, 3040, 21897, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:53', '2021-07-06 09:22:53'),
(21144, 3040, 21897, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   ThanksEmail sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:23', '2021-07-26 15:03:23'),
(21145, 11056, 21897, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:16:04', '2021-08-11 10:16:04'),
(21146, 3040, 21897, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   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, '2021-08-18 15:07:07', '2021-08-18 15:07:07'),
(21147, 10057, 21897, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:46:50', '2021-10-08 11:46:50'),
(21148, 10057, 21897, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:56:22', '2021-11-15 10:56:22'),
(21149, 3040, 21898, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:15:06', '2021-03-16 12:15:06'),
(21150, 3040, 21898, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:13:36', '2021-05-28 14:13:36'),
(21151, 3040, 21898, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:53', '2021-06-17 09:06:53'),
(21152, 3040, 21898, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:07', '2021-06-17 09:07:07'),
(21153, 3040, 21898, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:52', '2021-07-06 09:22:52'),
(21154, 3040, 21898, NULL, '2021-08-04 00:00:00.000', 'In Process', '	 Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-28 12:02:28', '2021-07-28 12:02:28'),
(21155, 11056, 21898, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:23:34', '2021-08-11 10:23:34'),
(21156, 10057, 21898, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the status about the request for provider locations.  Provider Name	NPI Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189   Please feel free to reach out to us for any further questions.  Thanks & Regards,', NULL, NULL, '2021-10-06 14:03:19', '2021-10-06 14:03:19'),
(21157, 10057, 21898, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:46:35', '2021-10-08 11:46:35'),
(21158, 10057, 21898, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Evening,  Hope this email finds you well. I want to know the enrollment status for below mentioned providers under TIN.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Joseph, Vibitha	1952931560 Jose, Julie	1447883061 Brown, Brittany	1275163537 Abraham, Glory	1194206490  Please get back to me as soon as you get a chance. Have a great weekend ahead!  Thanks & Regards,', NULL, NULL, '2021-11-19 18:13:27', '2021-11-19 18:13:27'),
(21159, 10057, 21898, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From: Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,  Thank you for your inquiry.  Please complete the attached contract request form for each provider and submit with a valid W9.   The forms and the W9 must be sent together to the contracting mailbox MHTContractrequest@Molinahealthcare.com.', NULL, NULL, '2021-12-01 13:25:47', '2021-12-01 13:25:47'),
(21160, 10057, 21898, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon Michele,  Thank you for reaching out and providing the updated information. I have filled out both provider forms and email on the mentioned email address.  Meanwhile if you need any other details please let me know.  Thanks & Regards,', NULL, NULL, '2021-12-08 11:02:57', '2021-12-08 11:02:57'),
(21161, 10057, 21898, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com, MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Please let me know the updated status for the below mentioned request.  Thanks & Regards,', NULL, NULL, '2021-12-14 11:38:36', '2021-12-14 11:38:36'),
(21162, 10057, 21898, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  The request hasn’t been assigned for processing at this time.   Please allow time for the intake coordinator to process the request.', NULL, NULL, '2021-12-21 11:06:23', '2021-12-21 11:06:23'),
(21163, 10057, 21898, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thank you for your response. Please let me know once you get any update.  Regards,', NULL, NULL, '2021-12-28 15:06:45', '2021-12-28 15:06:45'),
(21164, 20067, 21898, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning, Hope this Email finds you well. Any update on the below-mentioned request.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 12:16:21', '2022-01-12 12:16:21'),
(21165, 20067, 21898, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Jaya Jacob - The request is under credentialing.  Please allow a few more weeks for the credentialing application to process.  Once approved the request will be sent for loading in the billing system.     Jeena Abraham -  The provider was loaded effective 12/1/2017 under all plans – welcome letter sent previously.     Thank You,', NULL, NULL, '2022-01-12 12:40:48', '2022-01-12 12:40:48'),
(21166, 20067, 21898, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub:Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Thanks for the update,  What about Brittany Brown NPI: 1275163537', NULL, NULL, '2022-01-12 12:42:56', '2022-01-12 12:42:56'),
(21167, 20067, 21898, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Hope this email finds you in good spirits. I would like to know the enrollment status of the below-mentioned provider.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 Jeny John	1073019493 Brittany Brown	1275163537  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-20 10:58:09', '2022-01-20 10:58:09'),
(21168, 20067, 21898, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email Received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the updates below for each provider.     Jeny John -  Please allow a few more weeks for the credentialing application to process.   Once approved the request will be sent for loading in the billing system.     There  is no request on file for the remaining providers under the below TIN.    Please submit a contract request form for both providers if you haven’t already done so.  Please remember to submit an updated W9 with contract request forms and send to MHTContractrequest@Molinahealthcare.com.     Thank You,', NULL, NULL, '2022-01-28 15:26:04', '2022-01-28 15:26:04'),
(21169, 20067, 21898, NULL, '2022-02-23 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele!  Thanks for the update kindly see the attached contract request for both providers.  Thank you, Syed Ahad', NULL, NULL, '2022-02-16 15:19:03', '2022-02-16 15:19:03'),
(21170, 20067, 21898, NULL, '2022-03-10 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub: Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Good Morning,     The providers have been loaded in the billing system effective 3/15/2022 under all plans.', NULL, NULL, '2022-03-03 15:14:43', '2022-03-03 15:14:43'),
(21171, 3040, 21899, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:15:15', '2021-03-16 12:15:15'),
(21172, 3040, 21899, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: No Subject  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 14:13:38', '2021-05-28 14:13:38'),
(21173, 3040, 21899, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:06:51', '2021-06-17 09:06:51'),
(21174, 3040, 21899, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: MHMSProviderContracting@molinahealthcare.com, MHTXProviderServices@molinahealthcare.com, MHT.Credentialing@molinahealthcare.com, Jasmine.Guerrero@molinahealthcare.com, david.balli@molinahealthcare.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you  ', NULL, NULL, '2021-06-17 09:07:05', '2021-06-17 09:07:05'),
(21175, 3040, 21899, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Moilna Healthcare for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 09:22:51', '2021-07-06 09:22:51'),
(21176, 3040, 21899, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Hello Thomas,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Molina Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Also please add the below mentioned providers under the below highlighted locations.   Provider 1:   Provider Name: Jose, Julie  Provider NPI# 1447883061 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 2:   Provider Name: Brown, Brittany  Provider NPI# 1275163537 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 3:   Provider Name: Abraham, Glory  Provider NPI# 1194206490 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060 Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 4:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 5:   Provider Name: Joseph, Vibitha  Provider NPI# 1952931560 Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-07-26 15:03:28', '2021-07-26 15:03:28');
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
(21177, 11056, 21899, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Fwd: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning,     Thank you for your inquiry.   Please see the status for each provider listed below.   Please submit a roster or change information form for the providers that you would like to add under another location.     Ani Stephen –   Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     James Piccione Jr – The request on hold awaiting your response from the email sent asking to confirm the provider specialty.   The contract request form list Emergency Medicine and the provider shows credentialed under Family Medicine.  Please advise which specialty we should proceed with.     Mini Chennemkara – The request is under the final step.  The request has been sent for loading in the billing system.  Please follow up after 9/1/21.     Limy Fernandus - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Odette Kourouma – The CAQH application has been attested and the request has been sent to credentialing for processing.  Please update the CAQH application to allow Molina authorization.     Cini Thomas - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.     Sigi Paul - Please allow a few more weeks for the credentialing application to process.  Once approved for credentialing the request will be sent for loading in the billing system.  This process pay may take 30-45days to complete.  Thank You,    Michele Thomas-Martin Associate Specialist, Provider Contracts 1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-11 10:14:10', '2021-08-11 10:14:10'),
(21178, 3040, 21899, NULL, '2021-08-25 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||   Hello Thomas,   Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Molina Healthcare in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Stephen, Ani  Provider NPI# 1588959118  Provider 2:   Provider Name: Piccione JR, James M  Provider NPI# 1356321509  Provider 3:   Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956  Provider 4:   Provider Name: Fernandus, Limy  Provider NPI# 1972005189  Provider 5:   Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Provider 6:   Provider Name: Thomas, Cini  Provider NPI# 1134777238  Provider 7:   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, '2021-08-18 15:07:11', '2021-08-18 15:07:11'),
(21179, 10057, 21899, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Morning Michele,  Thank you for reaching out to me, could you please let me know that all the locations are listed for the mentioned providers, also please assist me to search for providers in the provider directory.  Thanks & Regards,', NULL, NULL, '2021-10-08 11:46:27', '2021-10-08 11:46:27'),
(21180, 10057, 21899, NULL, '2021-11-22 00:00:00.000', 'Approved', 'Email Received From : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || Molina Health ||  Good Afternoon,  Thank you for your inquiry.   Please see the welcome letters for all the below providers except James Piccione.  The request for James is still in process please allow a few more weeks for the request to complete.  The providers have been added under all service locations.  Molly Joseph -  The request complete  - attached welcome letter.  Thank You,  Michele Thomas-Martin', NULL, NULL, '2021-11-15 10:55:55', '2021-11-15 10:55:55'),
(21181, 3040, 21900, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:16:00', '2021-03-16 12:16:00'),
(21182, 3040, 21900, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:39', '2021-05-28 16:26:39'),
(21183, 3040, 21900, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:35', '2021-06-17 11:18:35'),
(21184, 3040, 21900, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:29', '2021-07-06 11:57:29'),
(21185, 3040, 21900, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:48', '2021-07-27 16:41:48'),
(21186, 11056, 21900, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:00:38', '2021-08-09 13:00:38'),
(21187, 3040, 21900, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:15', '2021-08-20 16:46:15'),
(21188, 3040, 21901, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:16:16', '2021-03-16 12:16:16'),
(21189, 3040, 21901, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:43', '2021-05-28 16:26:43'),
(21190, 3040, 21901, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:33', '2021-06-17 11:18:33'),
(21191, 3040, 21901, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:29', '2021-07-06 11:57:29'),
(21192, 3040, 21901, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you ', NULL, NULL, '2021-07-28 12:01:37', '2021-07-28 12:01:37'),
(21193, 1006, 21901, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:11', '2021-08-03 10:32:11'),
(21194, 11056, 21901, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 13:00:10', '2021-08-09 13:00:10'),
(21195, 3040, 21901, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:44', '2021-08-20 16:46:44'),
(21196, 3040, 21901, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:47:16', '2021-08-20 16:47:16'),
(21197, 3040, 21902, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:16:44', '2021-03-16 12:16:44'),
(21198, 3040, 21902, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:47', '2021-05-28 16:26:47'),
(21199, 3040, 21902, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:30', '2021-06-17 11:18:30'),
(21200, 3040, 21902, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:28', '2021-07-06 11:57:28'),
(21201, 3040, 21902, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:44', '2021-07-27 16:41:44'),
(21202, 11056, 21902, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:56:34', '2021-08-09 12:56:34'),
(21203, 3040, 21902, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:31', '2021-08-20 16:46:31'),
(21204, 3040, 21903, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:17:00', '2021-03-16 12:17:00'),
(21205, 3040, 21903, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:51', '2021-05-28 16:26:51'),
(21206, 3040, 21903, NULL, '2021-06-24 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment.', NULL, NULL, '2021-06-17 10:11:57', '2021-06-17 10:11:57'),
(21207, 3040, 21904, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:17:22', '2021-03-16 12:17:22'),
(21208, 3040, 21904, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:54', '2021-05-28 16:26:54'),
(21209, 3040, 21904, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:25', '2021-06-17 11:18:25'),
(21210, 3040, 21904, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:27', '2021-07-06 11:57:27'),
(21211, 3040, 21904, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:47', '2021-07-27 16:41:47'),
(21212, 11056, 21904, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:56:13', '2021-08-09 12:56:13'),
(21213, 3040, 21904, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:46:26', '2021-08-20 16:46:26'),
(21214, 3046, 21905, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:17:36', '2021-03-16 12:17:36'),
(21215, 1006, 21905, NULL, '2021-04-06 00:00:00.000', 'Approved', 'Katherine is enrolled with Multiplan and PHCS, approval confirmation and location information is attached for reference.   MultiPlan Network 03/22/2016 - Present Product Effective Period MultiPlan	 03/22/2016 - 	Present MultiPlan Auto Medical	 03/22/2016 - 	Present MultiPlan Workers\' Compensation	 03/22/2016 - 	Present PHCS Network 02/01/2017 - Present Product Effective Period PHCS	 02/01/2017 - 	Present ', NULL, NULL, '2021-03-30 10:05:09', '2021-03-30 10:05:09'),
(21216, 3040, 21906, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:17:46', '2021-03-16 12:17:46'),
(21217, 3040, 21906, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:26:58', '2021-05-28 16:26:58'),
(21218, 3040, 21906, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:22', '2021-06-17 11:18:22'),
(21219, 3040, 21906, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:27', '2021-07-06 11:57:27'),
(21220, 3040, 21906, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:49', '2021-07-27 16:41:49'),
(21221, 11056, 21906, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:55:15', '2021-08-09 12:55:15'),
(21222, 3040, 21906, NULL, '2021-08-27 00:00:00.000', 'Approved', 'Provider is participating with Multiplan. Please see attachment. ', NULL, NULL, '2021-08-20 16:45:57', '2021-08-20 16:45:57'),
(21223, 3040, 21907, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:17:55', '2021-03-16 12:17:55');
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
(21224, 3040, 21907, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:27:02', '2021-05-28 16:27:02'),
(21225, 1005, 21907, 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 13:02:52', '2021-06-01 13:02:52'),
(21226, 3046, 21908, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:18:02', '2021-03-16 12:18:02'),
(21227, 1006, 21908, NULL, '2021-04-06 00:00:00.000', 'Initiated', 'Submitted enrollment request and group addition for provider for all addresses:  MultiPlan has received your inquiry.  One of our Customer Service representatives will research and respond to you via email with updates and/or resolution. You can check status and make updates to this case online.  Case Number: 7561360    Submitter Name: Brad Peterson Date of Submission: 03/30/2021    TIN: 46-0575924    Provider Name: Unknown, Unknown Group Name: Statcare Minor Emergency Clinic Inquiry Type: Data Maintenance • Add a Practitioner with a CAQH#    Priority: Standard ', NULL, NULL, '2021-03-30 14:30:11', '2021-03-30 14:30:11'),
(21228, 1006, 21908, NULL, '2021-05-05 00:00:00.000', 'In Process', 'We received the following email from Multiplan @ PortalRegistrar PortalRegistrar@multiplan.com:  Sub: FW: Contract ID 9671500 Case # 7561360  \"Dear Brad Peterson,  Additional information is required for Rose Puentes  Please answer the following questions to aid in processing:  Does this practitioner accept direct referrals to see enrollees?  Should the practitioner be listed in the MultiPlan directory for enrollee referrals?  Please reopen case with your response to the above questions so processing can continue.  Thank you.\"  Reopened the case and submitted the answers. ', NULL, NULL, '2021-04-28 15:36:01', '2021-04-28 15:36:01'),
(21229, 1006, 21908, NULL, '2021-05-07 00:00:00.000', 'In Process', 'We received the following email from appmissinginfo fax7814878257@multiplan.com:  Sub: Regarding Trevino, Rose P., PAC\'s MultiPlan Application – Reference: APP0008202553  \"We have received your request but additional information is required to proceed, please see attached. The requested information can be submitted by emailing appmissinginfo@multiplan.com or via fax to 781-487-8257.  Please contact MultiPlan\'s Customer Service department for any questions regarding this request. You may also inquire about application status, inquire about your fee schedule or address general questions through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry. Follow this link to get started https://custservice.multiplan.com.  Sriyanka  D Provider Data Management appmissinginfo@multiplan.com  MultiPlan, Inc 16 Crosby Drive Bedford, MA 01730 Fax: 781-487-8257 Reference: APP0008202553\"  The form was filled out and sent to Multiplan.', NULL, NULL, '2021-04-30 08:28:48', '2021-04-30 08:28:48'),
(21230, 1006, 21908, NULL, '2021-05-20 00:00:00.000', 'In Process', 'We received an email from Multiplan stating that provider has a BHS degree and is unable to be credentialed but she would still be able to bill under the group contract, informed billing team to go ahead and do so. Will update task once claim status is received. ', NULL, NULL, '2021-05-10 13:38:48', '2021-05-10 13:38:48'),
(21231, 1006, 21908, NULL, '2021-07-03 00:00:00.000', 'In Process', 'Sent f/u email to billing team: \"Hello,  I wanted to check in with you to see if any claims were received and sent out for Rose Trevino yet?  Thank you.\"', NULL, NULL, '2021-06-03 10:34:30', '2021-06-03 10:34:30'),
(21232, 1006, 21908, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-06-21 16:06:03', '2021-06-21 16:06:03'),
(21233, 1006, 21908, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time. ', NULL, NULL, '2021-07-05 13:48:17', '2021-07-05 13:48:17'),
(21234, 1006, 21908, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Still pending on claims. Need to allow more time.  ', NULL, NULL, '2021-08-17 17:17:40', '2021-08-17 17:17:40'),
(21235, 11056, 21908, NULL, '2021-09-28 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-09-21 14:15:21', '2021-09-21 14:15:21'),
(21236, 11056, 21908, NULL, '2021-10-11 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-04 10:59:01', '2021-10-04 10:59:01'),
(21237, 11056, 21908, NULL, '2021-10-21 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-14 12:45:40', '2021-10-14 12:45:40'),
(21238, 11056, 21908, NULL, '2021-11-01 00:00:00.000', 'In Process', '	 We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-10-25 12:35:59', '2021-10-25 12:35:59'),
(21239, 11056, 21908, NULL, '2021-11-18 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-11 13:21:47', '2021-11-11 13:21:47'),
(21240, 11056, 21908, NULL, '2021-12-01 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-11-24 17:10:02', '2021-11-24 17:10:02'),
(21241, 11056, 21908, NULL, '2021-12-17 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-10 17:30:43', '2021-12-10 17:30:43'),
(21242, 11056, 21908, NULL, '2021-12-30 00:00:00.000', 'In Process', 'We are still pending any claims for this provider from billing team to verify if she is enrolled under group contract or not. ', NULL, NULL, '2021-12-23 10:27:03', '2021-12-23 10:27:03'),
(21243, 19067, 21908, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  I would like to know the enrollment status of the following providers with mentioned locations.   Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Provider Name	NPI	Location Rose Trevino	1437174794	500 E Caesar, Kingsville, TX 78363 Rose Trevino	1437174794	4042 River Hill, Corpus Christi, TX 78410 Rose Trevino	1437174794	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Rose Trevino	1437174794	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	500 E Caesar, Kingsville, TX 78363 Elsa Pearce	1083784102	4042 River Hill, Corpus Christi, TX 78410 Elsa Pearce	1083784102	6646 S. Staples ST# 122, Corpus Christi, TX 78413 Elsa Pearce	1083784102	3817 South Padre Island Drive, Corpus Christi, TX 78415 Elsa Pearce	1083784102	2102 FM 2165 Rockport, TX 78382    And if any provider is enrolled then provide us with the Effective Date and Welcome Kit.  Kindly respond promptly.  Have a nice day! Hammad Ahmed.', NULL, NULL, '2022-01-12 17:24:52', '2022-01-12 17:24:52'),
(21244, 19067, 21908, NULL, '2022-02-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Greetings!  Hope this email finds you well.  Any updates on the request below?  Kindly respond promptly.   Regards, Hammad', NULL, NULL, '2022-01-26 17:28:45', '2022-01-26 17:28:45'),
(21245, 19067, 21908, NULL, '2022-02-18 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  Hope you are doing well.  This is my SECOND REMINDER on the previously mentioned request. Kindly respond as per your convenience.   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-11 14:37:56', '2022-02-11 14:37:56'),
(21246, 19067, 21908, NULL, '2022-03-02 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, fax7814878257@multiplan.com  Subject: Re: Enrollment Query || RHC || Elsa & Rose || Multiplan ||   Hello!  I haven\'t heard from you for a long time now. Kindly get back to me with some updates on my request.  Waiting to hear from you soon!   Regards, Hammad Ahmed.', NULL, NULL, '2022-02-23 14:28:52', '2022-02-23 14:28:52'),
(21247, 19067, 21908, NULL, '2022-03-22 00:00:00.000', 'In Process', 'Spoke with Melini she said that the providers are in process of getting loaded into their systems. Please allow more time.', NULL, NULL, '2022-03-15 16:19:27', '2022-03-15 16:19:27'),
(21248, 3040, 21909, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:18:10', '2021-03-16 12:18:10'),
(21249, 3040, 21909, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:27:06', '2021-05-28 16:27:06'),
(21250, 3040, 21909, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:19', '2021-06-17 11:18:19'),
(21251, 3040, 21909, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:26', '2021-07-06 11:57:26'),
(21252, 3040, 21909, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:41:46', '2021-07-27 16:41:46'),
(21253, 1006, 21909, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:30:39', '2021-08-03 10:30:39'),
(21254, 11056, 21909, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:55:52', '2021-08-09 12:55:52'),
(21255, 11056, 21909, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:55:53', '2021-08-09 12:55:53'),
(21256, 3040, 21909, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:53', '2021-08-23 13:49:53'),
(21257, 10057, 21909, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:57:26', '2021-10-07 16:57:26'),
(21258, 10057, 21909, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:34:09', '2021-11-22 09:34:09'),
(21259, 10057, 21909, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:47:57', '2021-12-02 13:47:57'),
(21260, 10057, 21909, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:18:49', '2021-12-09 11:18:49'),
(21261, 10057, 21909, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:44:03', '2021-12-16 14:44:03'),
(21262, 10057, 21909, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:28:07', '2021-12-22 11:28:07'),
(21263, 10057, 21909, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:57:18', '2021-12-29 11:57:18'),
(21264, 20067, 21909, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:19', '2022-01-12 17:42:19'),
(21265, 20067, 21909, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:43', '2022-01-18 17:00:43'),
(21266, 20067, 21909, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Check status through portal  Dear Steve Albert,  Thank you for contacting our Service Department for MultiPlan/PHCS. We would be happy to assist you with a demographic update. Please submit your requested changes on letterhead signed by the group administrator or duly authorized representative along with the group name, address and TIN affiliated with the group.  Please fax the information to our Registrar department at (781) 487-8273 or email registrar@multiplan.com.  If you have any questions regarding your current inquiry, please contact our Customer Service department at 800-950-7040 with reference to your Case # 7901374. You may re-open a closed case using the Portal if you have further inquiry on the same case.  Sent to: nucc@claimsmedinc.com', NULL, NULL, '2022-02-21 17:31:38', '2022-02-21 17:31:38'),
(21267, 20067, 21909, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Fax the letterhead to (781) 487-8273  See the attachment', NULL, NULL, '2022-03-16 14:52:04', '2022-03-16 14:52:04'),
(21268, 19067, 21909, NULL, '2022-04-29 00:00:00.000', 'Not Eligible', 'The provider is no longer with the group.', NULL, NULL, '2022-04-22 11:26:52', '2022-04-22 11:26:52'),
(21269, 3040, 21910, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:18:32', '2021-03-16 12:18:32'),
(21270, 3040, 21910, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:27:09', '2021-05-28 16:27:09'),
(21271, 3040, 21910, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:16', '2021-06-17 11:18:16'),
(21272, 3040, 21910, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:25', '2021-07-06 11:57:25'),
(21273, 3040, 21910, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:27', '2021-07-27 16:42:27'),
(21274, 1006, 21910, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:31:17', '2021-08-03 10:31:17'),
(21275, 11056, 21910, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:54:19', '2021-08-09 12:54:19'),
(21276, 3040, 21910, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:55', '2021-08-23 13:49:55'),
(21277, 12062, 21910, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Replied to a below email via fax; See attached file faxed.  From: noreplycustserv@multiplan.com Subject: Initial request for additional information regarding case number 7612872  Thank you for your inquiry. To expedite your request we will need additional information. For your convenience we have listed the required documents below and attached coversheet(s) to be used when faxing in your documents.  In order for us to complete your inquiry, we must receive all requested documentation by 09/02/2021 or your case will be closed. Once all documents are received, your case will be re-opened and researched in full.  Documentation Required	Additional Description	Status Misc Application Missing Materials	Jacob, Jaya - Professional liability insurance; Admitting privileges or other admitting arrangements with participating hospital	Not Received Thank you, Service Operations   ', NULL, NULL, '2021-09-23 16:31:21', '2021-09-23 16:31:21'),
(21278, 10057, 21910, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:57:02', '2021-10-07 16:57:02'),
(21279, 10057, 21910, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:34:04', '2021-11-22 09:34:04'),
(21280, 10057, 21910, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:47:51', '2021-12-02 13:47:51'),
(21281, 10057, 21910, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:18:43', '2021-12-09 11:18:43'),
(21282, 10057, 21910, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:43:57', '2021-12-16 14:43:57'),
(21283, 10057, 21910, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:28:01', '2021-12-22 11:28:01'),
(21284, 10057, 21910, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:57:13', '2021-12-29 11:57:13'),
(21285, 20067, 21910, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:10', '2022-01-12 17:42:10'),
(21286, 20067, 21910, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:36', '2022-01-18 17:00:36'),
(21287, 20067, 21910, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Check status through portal  Dear Steve Albert,  Thank you for contacting our Service Department for MultiPlan/PHCS. We would be happy to assist you with a demographic update. Please submit your requested changes on letterhead signed by the group administrator or duly authorized representative along with the group name, address and TIN affiliated with the group.  Please fax the information to our Registrar department at (781) 487-8273 or email registrar@multiplan.com.  If you have any questions regarding your current inquiry, please contact our Customer Service department at 800-950-7040 with reference to your Case # 7901374. You may re-open a closed case using the Portal if you have further inquiry on the same case.  Sent to: nucc@claimsmedinc.com', NULL, NULL, '2022-02-21 17:31:33', '2022-02-21 17:31:33'),
(21288, 20067, 21910, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Fax the letterhead to (781) 487-8273  See the attachment', NULL, NULL, '2022-03-16 14:51:41', '2022-03-16 14:51:41'),
(21289, 3040, 21911, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:18:43', '2021-03-16 12:18:43'),
(21290, 3040, 21911, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 16:27:12', '2021-05-28 16:27:12'),
(21291, 3040, 21911, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Multiplan ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Multiplan for our group Longpoint Medical Center under the below location.   Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: 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: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 11:18:15', '2021-06-17 11:18:15'),
(21292, 3040, 21911, NULL, '2021-07-13 00:00:00.000', 'In Process', 'I had a word with Dan Multiplan representative and he said under the group contract we have all three location  (NUCC, IVUC & LPMC). He advised to send the LOI through fax and they can process our request. Also he said LPMC is not contracted separately because that already coming under the NUCC tax ID .  Case # 7660656', NULL, NULL, '2021-07-06 11:57:25', '2021-07-06 11:57:25');
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
(21293, 3040, 21911, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com  Subject: Letter of Intent || NUCC, IVUC & LPMC || Providers || Multiplan ||  Greetings,   Hope you are doing well. Please find attached Letter of Intent as per request of (Sam) Multiplan representative and he advises to send it through email as per him Multiplan did not receive the fax.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly  Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493   Thank you  ', NULL, NULL, '2021-07-27 16:42:07', '2021-07-27 16:42:07'),
(21294, 1006, 21911, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received a fax from Multiplan requesting specialty information for the provider, replied @ registrarmissinginfo@multiplan.com:  Sub: Missing Items Request   \"Hello,   Please find the requested information, do let me know if you need any other information.   Thank you. \"', NULL, NULL, '2021-08-03 10:32:47', '2021-08-03 10:32:47'),
(21295, 11056, 21911, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good morning!  Hope you are doing well. I want to inquire about the enrollment status of the following providers and practices for the Multiplan.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider Details: Provider 1:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 2:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 3:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 4:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 5:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 6:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 7:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 12:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 13:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 14:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 15:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any information or documents feel free to reach out to me. Waiting for your response.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 12:54:09', '2021-08-09 12:54:09'),
(21296, 3040, 21911, NULL, '2021-08-30 00:00:00.000', 'In Process', 'I had a with Multiplan representative and she said the provider profile is not created so she will request to create a provider profile.   Case # 7660656', NULL, NULL, '2021-08-23 13:49:54', '2021-08-23 13:49:54'),
(21297, 10057, 21911, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Evening!  Hope this email finds you well. I want to inquire about the updated enrollment status of the following providers and practices for the Multiplan.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Brown, Brittany	1275163537 Stephen, Ani	1588959118 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Abraham, Jeena	1467901587 Kourouma , Odette Tiranke	1134525868 Fernandus, Limy	1972005189 Joseph, Molly	1073019493 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Jose, Julie	1447883061 Piccione JR, James M	1356321509 Abraham, Glory	1194206490 Joseph, Vibitha	1952931560 John, Jeny	1073019493  Looking forward to your response. Have a great evening!  Thanks & Regards,', NULL, NULL, '2021-10-07 16:54:47', '2021-10-07 16:54:47'),
(21298, 10057, 21911, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing well. Please let me know the latest enrollment status for the below mentioned providers and groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Stephen, Ani	1588959118 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Piccione JR, James M	1356321509  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 09:33:58', '2021-11-22 09:33:58'),
(21299, 10057, 21911, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Hello,  Can I get the latest updates on the below mentioned providers enrollment request?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:47:45', '2021-12-02 13:47:45'),
(21300, 10057, 21911, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com & registrarmissinginfo@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good Morning,  Hope you are doing great. I\'m writing this email to check the latest update on the below mentioned request. It is my second reminder.  Looking forward to your earliest response.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:18:37', '2021-12-09 11:18:37'),
(21301, 10057, 21911, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Please do not respond to this email. Registrar only handles first time submissions to update your information.  You may inquire about submission status, request a contract copy or inquire about your fee schedule through MultiPlan\'s customer service portal. There is no log-in or account set-up required. Simply select \"Rendering Practitioner/Facility\" and follow the on screen instructions in order to submit your inquiry.https://provider.multiplan.com.  If you need assistance navigating the portal please contact customer service at 800-950-7040.  When submitting missing information please email the information registrarmissinginfo@multiplan.com or via fax to 781-487-8278.', NULL, NULL, '2021-12-16 14:43:52', '2021-12-16 14:43:52'),
(21302, 10057, 21911, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Thank you for your response. I have tried to get the details from the portal as well but it has not worked, is there any way that any person from the credentialing department can contact me?  Call back number - 713-893-6214  It will be very helpful for me. Have a great day!  Regards,', NULL, NULL, '2021-12-22 11:27:55', '2021-12-22 11:27:55'),
(21303, 10057, 21911, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : registrar@multiplan.com  Sub : Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Still waiting to get a response from your side?  Regards,', NULL, NULL, '2021-12-29 11:57:07', '2021-12-29 11:57:07'),
(21304, 20067, 21911, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan  Good afternoon, Hope this email finds you in good health. Any Updates on the previously mentioned request?  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 17:42:02', '2022-01-12 17:42:02'),
(21305, 20067, 21911, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: registrar@multiplan.com, registrarmissinginfo@multiplan.com  Sub: Re: Enrollment Status Query - NUCC - IVUC - LPMC - Multiplan   Good afternoon!  Hope this email finds you in good health. It\'s been a long time I\'ve not heard from you Kindly respond promptly.  Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-18 17:00:29', '2022-01-18 17:00:29'),
(21306, 20067, 21911, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Check status through portal  Dear Steve Albert,  Thank you for contacting our Service Department for MultiPlan/PHCS. We would be happy to assist you with a demographic update. Please submit your requested changes on letterhead signed by the group administrator or duly authorized representative along with the group name, address and TIN affiliated with the group.  Please fax the information to our Registrar department at (781) 487-8273 or email registrar@multiplan.com.  If you have any questions regarding your current inquiry, please contact our Customer Service department at 800-950-7040 with reference to your Case # 7901374. You may re-open a closed case using the Portal if you have further inquiry on the same case.  Sent to: nucc@claimsmedinc.com', NULL, NULL, '2022-02-21 17:31:24', '2022-02-21 17:31:24'),
(21307, 20067, 21911, NULL, '2022-03-23 00:00:00.000', 'In Process', 'Fax the letterhead to (781) 487-8273  See the attachment', NULL, NULL, '2022-03-16 14:51:15', '2022-03-16 14:51:15'),
(21308, 3040, 21912, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:20:00', '2021-03-16 12:20:00'),
(21309, 1006, 21912, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Group is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached   ', NULL, NULL, '2021-05-17 11:59:41', '2021-05-17 11:59:41'),
(21310, 3040, 21913, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:20:12', '2021-03-16 12:20:12'),
(21311, 1006, 21913, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 01/06/2015. Screenshot is attached   ', NULL, NULL, '2021-05-17 12:02:06', '2021-05-17 12:02:06'),
(21312, 3040, 21914, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:20:26', '2021-03-16 12:20:26'),
(21313, 1006, 21914, NULL, '2021-05-24 00:00:00.000', 'Approved', 'The provider is enrolled with the insurance, approval is attached for reference.', NULL, NULL, '2021-05-17 14:15:38', '2021-05-17 14:15:38'),
(21314, 3040, 21915, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:20:41', '2021-03-16 12:20:41'),
(21315, 1006, 21915, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PTAN: P02442337 Eff: 01/29/2020 ', NULL, NULL, '2021-05-17 13:09:47', '2021-05-17 13:09:47'),
(21316, 3046, 21916, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:20:51', '2021-03-16 12:20:51'),
(21317, 1006, 21916, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	KATHERINE C RABAGOS NP PROVIDER PTAN	P01596057 PROVIDER NPI	1134415631 EFFECTIVE DATE	04/12/2014 END DATE 	 GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE', NULL, NULL, '2021-03-26 09:28:31', '2021-03-26 09:28:31'),
(21318, 3040, 21917, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:21:03', '2021-03-16 12:21:03'),
(21319, 1006, 21917, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	VIBITHA JOSEPH NP PROVIDER PTAN	P02530797 PROVIDER NPI	1952931560 EFFECTIVE DATE	02/11/2020 END DATE	 ', NULL, NULL, '2021-05-17 14:29:11', '2021-05-17 14:29:11'),
(21320, 3040, 21918, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:21:20', '2021-03-16 12:21:20'),
(21321, 1006, 21918, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	MINI P CHENNEMKARA NP PROVIDER PTAN	P02530830 PROVIDER NPI	1841755956 EFFECTIVE DATE	03/06/2020 END DATE	 ', NULL, NULL, '2021-05-17 13:11:52', '2021-05-17 13:11:52'),
(21322, 3040, 21919, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:21:42', '2021-03-16 12:21:42'),
(21323, 1006, 21919, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Effective date: 03/19/2020 Rail Road PTAN: P02442476 ', NULL, NULL, '2021-05-17 14:19:29', '2021-05-17 14:19:29'),
(21324, 3040, 21920, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:21:52', '2021-03-16 12:21:52'),
(21325, 1006, 21920, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 08/13/2018 ', NULL, NULL, '2021-05-17 14:17:38', '2021-05-17 14:17:38'),
(21326, 3040, 21921, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:04', '2021-03-16 12:22:04'),
(21327, 1006, 21921, NULL, '2021-05-24 00:00:00.000', 'Approved', 'Provider is showing linked with medicare railroad and effective date is 05/01/2019 ', NULL, NULL, '2021-05-17 12:03:36', '2021-05-17 12:03:36'),
(21328, 3040, 21922, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:15', '2021-03-16 12:22:15'),
(21329, 1006, 21922, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	JEENA ABRAHAM PROVIDER PTAN	P02531430 PROVIDER NPI	1467901587 EFFECTIVE DATE	04/22/2017 END DATE	 ', NULL, NULL, '2021-05-17 13:02:42', '2021-05-17 13:02:42'),
(21330, 3040, 21923, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:26', '2021-03-16 12:22:26'),
(21331, 1006, 21923, NULL, '2021-05-24 00:00:00.000', 'Not Eligible', 'The provider is no longer practicing under the groups.', NULL, NULL, '2021-05-17 11:54:50', '2021-05-17 11:54:50'),
(21332, 3040, 21924, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:36', '2021-03-16 12:22:36'),
(21333, 1006, 21924, NULL, '2021-05-24 00:00:00.000', 'Approved', 'PROVIDER NAME	ANI STEPHEN NP PROVIDER PTAN	P02531565 PROVIDER NPI	1588959118 EFFECTIVE DATE	02/07/2020 END DATE	 ', NULL, NULL, '2021-05-17 14:26:01', '2021-05-17 14:26:01'),
(21334, 3040, 21925, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:49', '2021-03-16 12:22:49'),
(21335, 1006, 21925, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001297 ', NULL, NULL, '2021-05-17 15:20:30', '2021-05-17 15:20:30'),
(21336, 3040, 21925, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:42', '2021-06-07 17:43:42'),
(21337, 3040, 21926, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:22:59', '2021-03-16 12:22:59'),
(21338, 1006, 21926, NULL, '2021-05-24 00:00:00.000', 'Initiated', 'Enrollment request submitted via the online portal.   Reference Number :	21137001293 ', NULL, NULL, '2021-05-17 15:20:19', '2021-05-17 15:20:19'),
(21339, 3040, 21926, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:37', '2021-06-07 17:43:37'),
(21340, 3040, 21927, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:23:07', '2021-03-16 12:23:07'),
(21341, 1006, 21927, NULL, '2021-05-24 00:00:00.000', 'Initiated', '	 Enrollment request submitted via the online portal.   Reference Number :	21137001290', NULL, NULL, '2021-05-17 15:19:54', '2021-05-17 15:19:54'),
(21342, 3040, 21927, NULL, '2021-06-14 00:00:00.000', 'Approved', 'Provider enrolled in Medicare Railroad.', NULL, NULL, '2021-06-07 17:43:32', '2021-06-07 17:43:32'),
(21343, 3046, 21928, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:23:30', '2021-03-16 12:23:30'),
(21344, 1006, 21928, NULL, '2021-04-02 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  GROUP NAME	RABAGOS HEALTH CARE PLLC GROUP PTAN	DW2792 GROUP NPI	1689924904 BUSINESS STATE	TX EFFECTIVE DATE	04/12/2014 END DATE	', NULL, NULL, '2021-03-26 09:23:31', '2021-03-26 09:23:31'),
(21345, 3040, 21929, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:23:47', '2021-03-16 12:23:47'),
(21346, 3040, 21929, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:14:10', '2021-05-21 14:14:10'),
(21347, 3040, 21929, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:37:57', '2021-05-31 14:37:57'),
(21348, 3040, 21929, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:32', '2021-06-17 13:43:32'),
(21349, 1006, 21929, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:09', '2021-07-01 15:44:09'),
(21350, 3040, 21929, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:34', '2021-07-16 17:05:34'),
(21351, 11056, 21929, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:57:56', '2021-08-12 08:57:56'),
(21352, 10057, 21929, NULL, '2021-10-14 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Chennemkara, Mini Philip	1841755956 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Thomas, Cini	1134777238  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks & Regards,', NULL, NULL, '2021-10-07 11:29:55', '2021-10-07 11:29:55'),
(21353, 10057, 21929, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:55:30', '2021-10-18 09:55:30'),
(21354, 10057, 21929, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:38', '2021-11-22 11:41:38'),
(21355, 10057, 21929, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:08:10', '2021-11-23 10:08:10'),
(21356, 10057, 21929, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 15:57:08', '2021-12-03 15:57:08'),
(21357, 10057, 21929, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:49', '2021-12-10 14:55:49'),
(21358, 10057, 21929, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 11:00:04', '2021-12-17 11:00:04'),
(21359, 10057, 21929, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:49', '2021-12-23 10:54:49'),
(21360, 10057, 21929, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:18:32', '2021-12-30 13:18:32'),
(21361, 19067, 21929, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:45:55', '2022-01-03 17:45:55'),
(21362, 20067, 21929, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:23:33', '2022-01-12 15:23:33'),
(21363, 20067, 21929, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health  Good Morning! Hope this email finds you in good health. I would like to know the enrollment status of the following providers and if they are enrolled kindly resend the welcome letters or request your ECM team to resend the letters.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI SIGI PAUL	1033623616 Jaya Jacob	1194336149  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-20 12:25:06', '2022-01-20 12:25:06'),
(21364, 20067, 21929, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:28:18', '2022-01-28 11:28:18'),
(21365, 20067, 21929, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub:  Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-02-21 15:02:37', '2022-02-21 15:02:37'),
(21366, 20067, 21929, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com, shp-networkdevelopment@superiorhealthplan.com  Sub: Re: Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Evening!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-03-08 17:32:57', '2022-03-08 17:32:57'),
(21367, 20067, 21929, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com  Sub: Enrollment Status || Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon,        Sigi Paul, NP Individual NPI 1033623616 has a status of Make Par which means the file has moved to the department who completes the loading of the provider.  Superior HealthPlan Account Management can confirm plan effective date and participation status.     We do not show that we have received a request to credential Jaya Jacob NPI 1194336149.  Have you submitted a request for the provider to be added to the group.                    Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name  NPI  Sigi Paul  1033623616  Jaya Jacob  1194336149     Thank You,', NULL, NULL, '2022-03-14 15:19:43', '2022-03-14 15:19:43'),
(21368, 3040, 21930, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:23:57', '2021-03-16 12:23:57'),
(21369, 3040, 21930, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:01', '2021-05-31 14:38:01'),
(21370, 3040, 21930, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:29', '2021-06-17 13:43:29'),
(21371, 1006, 21930, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:17', '2021-07-01 15:44:17'),
(21372, 3040, 21930, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:18', '2021-07-16 17:05:18'),
(21373, 11056, 21930, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:58:04', '2021-08-12 08:58:04'),
(21374, 3040, 21930, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:06', '2021-08-27 11:53:06'),
(21375, 10057, 21930, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:55:24', '2021-10-18 09:55:24'),
(21376, 10057, 21930, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good morning Steve  Hope all is well this Friday morning  Here is the information on the following Providers  ·        MINI PHILIP CHENNEMKARA  NPI#1841755956  under TID#270796429--- application completed with eff date of 8/1/2021  ·        SIGI PAUL NPI# under TID#270796429---- application completed with eff date of 9/1/2021  ·        JAYA JACOB NPI#1194336149  under TID#270796429 – application completed with eff date of 10/1/2021  ·        ABDUR RAUF NPI#1497726202 under TID#270796429--- application completed with eff date of 8/1/2021  ·        JAMES PICCIONE JR NPI#1356321509 under TID#270796429 – application completed with eff date of 10/1/2021  ·        CINI THOMAS NPI# 1134777238  under TID#270796429--- application completed with eff date of 8/1/2021  Veronica Botello Rocha Provider Relations Coord', NULL, NULL, '2021-11-22 11:33:47', '2021-11-22 11:33:47'),
(21377, 3040, 21931, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:24:08', '2021-03-16 12:24:08'),
(21378, 3040, 21931, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:16:27', '2021-05-21 14:16:27'),
(21379, 3040, 21931, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:08', '2021-05-31 14:38:08'),
(21380, 3040, 21931, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:26', '2021-06-17 13:43:26'),
(21381, 1006, 21931, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:20', '2021-07-01 15:44:20'),
(21382, 3040, 21931, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Provider is participating with Superior Health. Please see attachment. ', NULL, NULL, '2021-07-22 08:51:26', '2021-07-22 08:51:26'),
(21383, 3040, 21932, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:24:22', '2021-03-16 12:24:22');
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
(21384, 3040, 21932, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:12', '2021-05-31 14:38:12'),
(21385, 3040, 21932, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:22', '2021-06-17 13:43:22'),
(21386, 1006, 21932, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:26', '2021-07-01 15:44:26'),
(21387, 3040, 21932, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Provider is participating with Superior Health. Please see attachment. ', NULL, NULL, '2021-07-22 08:51:58', '2021-07-22 08:51:58'),
(21388, 3040, 21933, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:24:43', '2021-03-16 12:24:43'),
(21389, 3040, 21933, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:33', '2021-05-31 14:38:33'),
(21390, 3040, 21933, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:19', '2021-06-17 13:43:19'),
(21391, 1006, 21933, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:29', '2021-07-01 15:44:29'),
(21392, 3040, 21933, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:24', '2021-07-16 17:05:24'),
(21393, 11056, 21933, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:58:15', '2021-08-12 08:58:15'),
(21394, 3040, 21933, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:11', '2021-08-27 11:53:11'),
(21395, 3040, 21933, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: Fwd: MINI PHILIP CHENNEMKARA WELCOME LETTER  MINI PHILIP CHENNEMKARA  NORMANDY URGENT CARE CENTER PA  ASK@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is: 08/01/2021                                                    C/ 53561', NULL, NULL, '2021-09-09 14:01:08', '2021-09-09 14:01:08'),
(21396, 3040, 21934, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:25:04', '2021-03-16 12:25:04'),
(21397, 3040, 21934, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:13:24', '2021-05-21 14:13:24'),
(21398, 3040, 21934, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:37', '2021-05-31 14:38:37'),
(21399, 3040, 21934, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:15', '2021-06-17 13:43:15'),
(21400, 1006, 21934, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:32', '2021-07-01 15:44:32'),
(21401, 3040, 21934, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:21', '2021-07-16 17:05:21'),
(21402, 11056, 21934, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:58:27', '2021-08-12 08:58:27'),
(21403, 3040, 21934, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:03', '2021-08-27 11:53:03'),
(21404, 3040, 21934, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Email rcvd from: ECMExecutionTeam@superiorhealthplan.com  Subject: Fwd: CINI THOMAS WELCOME LETTER  CINI THOMAS  NORMANDY URGENT CARE CENTER PA  ASK@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:  08/01/2021                                                    C/ 53559', NULL, NULL, '2021-09-09 14:15:29', '2021-09-09 14:15:29'),
(21405, 3040, 21935, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:25:43', '2021-03-16 12:25:43'),
(21406, 3040, 21935, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:40', '2021-05-31 14:38:40'),
(21407, 3040, 21935, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:10', '2021-06-17 13:43:10'),
(21408, 1006, 21935, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:35', '2021-07-01 15:44:35'),
(21409, 3040, 21935, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:26', '2021-07-16 17:05:26'),
(21410, 11056, 21935, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:58:35', '2021-08-12 08:58:35'),
(21411, 3040, 21935, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:09', '2021-08-27 11:53:09'),
(21412, 10057, 21935, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:55:19', '2021-10-18 09:55:19'),
(21413, 10057, 21935, NULL, '2021-11-29 00:00:00.000', 'Approved', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Good morning Steve  Hope all is well this Friday morning  Here is the information on the following Providers  ·        MINI PHILIP CHENNEMKARA  NPI#1841755956  under TID#270796429--- application completed with eff date of 8/1/2021  ·        SIGI PAUL NPI# under TID#270796429---- application completed with eff date of 9/1/2021  ·        JAYA JACOB NPI#1194336149  under TID#270796429 – application completed with eff date of 10/1/2021  ·        ABDUR RAUF NPI#1497726202 under TID#270796429--- application completed with eff date of 8/1/2021  ·        JAMES PICCIONE JR NPI#1356321509 under TID#270796429 – application completed with eff date of 10/1/2021  ·        CINI THOMAS NPI# 1134777238  under TID#270796429--- application completed with eff date of 8/1/2021  Veronica Botello Rocha Provider Relations Coord', NULL, NULL, '2021-11-22 11:31:50', '2021-11-22 11:31:50'),
(21414, 3040, 21936, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:25:55', '2021-03-16 12:25:55'),
(21415, 3040, 21936, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 09:05:04', '2021-05-21 09:05:04'),
(21416, 3046, 21937, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:25:56', '2021-03-16 12:25:56'),
(21417, 1006, 21937, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:21:26', '2021-03-31 15:21:26'),
(21418, 3046, 21938, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:00', '2021-03-16 12:26:00'),
(21419, 1006, 21938, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:21:34', '2021-03-31 15:21:34'),
(21420, 3046, 21939, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:02', '2021-03-16 12:26:02'),
(21421, 1006, 21939, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:21:39', '2021-03-31 15:21:39'),
(21422, 3046, 21940, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:04', '2021-03-16 12:26:04'),
(21423, 1006, 21940, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:21:44', '2021-03-31 15:21:44'),
(21424, 3040, 21941, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:06', '2021-03-16 12:26:06'),
(21425, 3040, 21941, NULL, '2021-05-28 00:00:00.000', 'Approved', 'Provider participating with Superior Healthplan. Please see attachment. ', NULL, NULL, '2021-05-21 08:45:17', '2021-05-21 08:45:17'),
(21426, 3046, 21942, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:07', '2021-03-16 12:26:07'),
(21427, 1006, 21942, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:21:55', '2021-03-31 15:21:55'),
(21428, 3046, 21943, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:08', '2021-03-16 12:26:08'),
(21429, 1006, 21943, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:22:01', '2021-03-31 15:22:01'),
(21430, 3046, 21944, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:10', '2021-03-16 12:26:10'),
(21431, 1006, 21944, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:22:15', '2021-03-31 15:22:15'),
(21432, 3046, 21945, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:12', '2021-03-16 12:26:12'),
(21433, 1006, 21945, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:22:52', '2021-03-31 15:22:52'),
(21434, 3046, 21946, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:15', '2021-03-16 12:26:15'),
(21435, 1006, 21946, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:22:57', '2021-03-31 15:22:57'),
(21436, 3046, 21947, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:18', '2021-03-16 12:26:18'),
(21437, 1006, 21947, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:23:02', '2021-03-31 15:23:02'),
(21438, 3040, 21948, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:20', '2021-03-16 12:26:20'),
(21439, 1005, 21948, 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 12:59:23', '2021-06-01 12:59:23'),
(21440, 3046, 21949, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:21', '2021-03-16 12:26:21'),
(21441, 1006, 21949, NULL, '2021-04-07 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Kingsville or Corpus Christi, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-03-31 15:23:06', '2021-03-31 15:23:06'),
(21442, 3040, 21950, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:38', '2021-03-16 12:26:38'),
(21443, 3040, 21950, NULL, '2021-05-28 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group under below locations.  Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 270796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider Name: Rauf., Abdur Provider NPI# 1497726202  Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider Name: Thomas, Cini Provider NPI# 1134777238  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-21 14:13:29', '2021-05-21 14:13:29'),
(21444, 3040, 21950, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:49', '2021-05-31 14:38:49'),
(21445, 3040, 21950, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:06', '2021-06-17 13:43:06'),
(21446, 1006, 21950, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:38', '2021-07-01 15:44:38'),
(21447, 3040, 21950, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Provider participating with Superior Health. Please see attachment', NULL, NULL, '2021-07-22 08:47:16', '2021-07-22 08:47:16'),
(21448, 3040, 21951, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:26:55', '2021-03-16 12:26:55'),
(21449, 3040, 21951, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:53', '2021-05-31 14:38:53'),
(21450, 3040, 21951, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:43:03', '2021-06-17 13:43:03'),
(21451, 1006, 21951, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:43', '2021-07-01 15:44:43'),
(21452, 3040, 21951, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:31', '2021-07-16 17:05:31'),
(21453, 11056, 21951, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:58:43', '2021-08-12 08:58:43'),
(21454, 3040, 21951, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:13', '2021-08-27 11:53:13'),
(21455, 10057, 21951, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:55:06', '2021-10-18 09:55:06'),
(21456, 10057, 21951, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:33', '2021-11-22 11:41:33'),
(21457, 10057, 21951, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:07:19', '2021-11-23 10:07:19');
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
(21458, 10057, 21951, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Ref # 69635 Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Good afternoon,  I hope all is well.   In review of NPI#1033623616 for provider Sigi Paul, I was not able to find them in our system.   As of today’s date, I don’t see an application received for your provider.   Below I will be attaching a link where you can submit an application on line.  Once you submit the application, our Network Development team with reach out to you within 5 business days acknowledging receipt of your request.    I hope this helps.  Have a great day.   https://www.superiorhealthplan.com/providers/become-a-provider.html     On the left hand side, select Add a Provider to an Existing Group Practice.   Thank you, Lionel Negrete', NULL, NULL, '2021-12-03 09:47:03', '2021-12-03 09:47:03'),
(21459, 10057, 21951, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:41', '2021-12-10 14:55:41'),
(21460, 10057, 21951, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:59:58', '2021-12-17 10:59:58'),
(21461, 10057, 21951, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:43', '2021-12-23 10:54:43'),
(21462, 10057, 21951, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:18:27', '2021-12-30 13:18:27'),
(21463, 19067, 21951, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:47:20', '2022-01-03 17:47:20'),
(21464, 20067, 21951, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:23:25', '2022-01-12 15:23:25'),
(21465, 20067, 21951, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health  Good Morning! Hope this email finds you in good health. I would like to know the enrollment status of the following providers and if they are enrolled kindly resend the welcome letters or request your ECM team to resend the letters.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI SIGI PAUL	1033623616 Jaya Jacob	1194336149  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-20 12:25:14', '2022-01-20 12:25:14'),
(21466, 20067, 21951, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:28:13', '2022-01-28 11:28:13'),
(21467, 20067, 21951, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub:  Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-02-21 15:02:32', '2022-02-21 15:02:32'),
(21468, 20067, 21951, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com, shp-networkdevelopment@superiorhealthplan.com  Sub: Re: Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Evening!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-03-08 17:32:49', '2022-03-08 17:32:49'),
(21469, 20067, 21951, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: shp-networkdevelopment@superiorhealthplan.com  Sub: PROVIDER PACKET || Sigi Paul || Longpoint Mdical Center || Superior Health  Good Afternoon!  Hope you are doing well. Attached is the provider packet For Jeny John.  Thank you, Syed Ahad.', NULL, NULL, '2022-03-09 12:29:50', '2022-03-09 12:29:50'),
(21470, 20067, 21951, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com  Sub: Enrollment Status || Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon,        Sigi Paul, NP Individual NPI 1033623616 has a status of Make Par which means the file has moved to the department who completes the loading of the provider.  Superior HealthPlan Account Management can confirm plan effective date and participation status.     We do not show that we have received a request to credential Jaya Jacob NPI 1194336149.  Have you submitted a request for the provider to be added to the group.                    Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name  NPI  Sigi Paul  1033623616  Jaya Jacob  1194336149     Thank You,', NULL, NULL, '2022-03-14 15:19:29', '2022-03-14 15:19:29'),
(21471, 19067, 21951, NULL, '2022-04-11 00:00:00.000', 'Approved', 'Email received from: ECMExecutionTeam@superiorhealthplan.com  Subject: SIGI PAUL WELCOME LETTER    SIGI PAUL  LONG POINT MEDICAL CENTER  LPMC@CLAIMSMEDINC.COM        Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve.Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.     Your effective date is:     04/01/2022                                                C/ 61876', NULL, NULL, '2022-04-04 12:25:30', '2022-04-04 12:25:30'),
(21472, 3040, 21952, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:27:04', '2021-03-16 12:27:04'),
(21473, 3040, 21952, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: Credentialing@superiorhealthplan.com  Subject: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:38:58', '2021-05-31 14:38:58'),
(21474, 3040, 21952, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health Plan ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Superior Healthplan in our group under the below location.  Practice Details: Practice Name:Longpoint Medical Center Practice Tax ID# 76-0612416 Practice NPI# 1770763815 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 2:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 6:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 7:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 8:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 9:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 10:   Provider Name: Jose, Julie Provider NPI# 1447883061  Waiting to hear from you soon.  Thank you ', NULL, NULL, '2021-06-17 13:42:52', '2021-06-17 13:42:52'),
(21475, 1006, 21952, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following email from SEMETRA.BRAZLE@superiorhealthplan.com:  Sub: Signature requested on \"ECM 546259 LONGPOINT MEDICAL CENTER\"  \"Semetra Brazle requests your signature on ECM 546259 LONGPOINT MEDICAL CENTER  Review and sign   Please Sign.  SEMETRA BRAZLE SEMETRA.BRAZLE@SUPERIORHEALTHPLAN.COM\"  The contract is signed and attached in the main group task for reference. ', NULL, NULL, '2021-07-01 15:44:46', '2021-07-01 15:44:46'),
(21476, 3040, 21952, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thanks  ', NULL, NULL, '2021-07-16 17:05:28', '2021-07-16 17:05:28'),
(21477, 11056, 21952, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@SuperiorHealthPlan.com  Sub  : Fwd: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello,  Adding AM Houston to the email, as the AM that assisted is in that service area.  Thank you,  Lydia Benavides Regional Manager Provider Relations Department  AM.CorpusChristi@Superiorhealthplan.com 800-656-4817-Opt 1 English, Opt 3 for Provider Relations', NULL, NULL, '2021-08-12 08:59:01', '2021-08-12 08:59:01'),
(21478, 3040, 21952, NULL, '2021-09-03 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings Brittney,  Hope you are doing well. Please advise the enrollment status for the below mentioned providers in Superior Health in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060    Practice Name: Longpoint Medical Center  Practice Tax ID# 270796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E Houston , TX 77055-4226       Provider 1:  Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956    Provider 2:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616     Provider 3:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Rauf., Abdur  Provider NPI# 1497726202     Provider 6:    Provider Name: Thomas, Cini  Provider NPI# 1134777238    Please get back to me as soon as you can get a chance. Waiting for your response.     Thank you   ', NULL, NULL, '2021-08-27 11:53:16', '2021-08-27 11:53:16'),
(21479, 12062, 21952, NULL, '2021-09-27 00:00:00.000', 'In Process', 'sent Collaborating Physicians Addendum  as requested on below mail. from :shaqueetta.blanchard@SuperiorHealthPlan.com  Sent mail is attached in attachments  Subject:Re: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149 Good afternoon,  I attempted to call today and was advised that the credentialing contact was not in. I have received a response in regards to the providers missing information. May you assist with information in order to avoid delay in credentialing.    We received your credentialing application for Jaya Jacob;  however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below: ☐ Collaborating Physicians Addendum                                   *Piccione,James is not currently contracted.   You may fax or email the requested information to the contact information listed below.   Fax: 866-702-4831               Phone: 1-800-820-5686   Thank you, Renay Blanchard Credentialing Specialist | Superior Health Plan Image 5900 Ben White Blvd  Austin, TX 78741 Phone: 800-218-7453 Ext 89185 Fax: 866-702-4831 shaqueetta.blanchard@SuperiorHealthPlan.com ', NULL, NULL, '2021-09-20 09:36:51', '2021-09-20 09:36:51'),
(21480, 12062, 21952, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Received  below email ; From:Credentialing@superiorhealthplan.com Subject : RE: OutreachAttempt#2: Credentialing Request; Jaya Jacob_1194336149  Good afternoon,              I am currently reflecting that this provider is awaiting approval by the medical director. If all goes well, the anticipated effective date will be 10/01/2021.  Thank you,  Credentialing Department | Superior Health Plan 5900 E. Ben White Blvd | Austin, TX 78741 Phone: 800-820-5686 |Fax: 866-702-4831 Credentialing@superiorhealthplan.com', NULL, NULL, '2021-09-21 12:43:19', '2021-09-21 12:43:19'),
(21481, 10057, 21952, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Greetings for the day!  Any update on the below request?  Thanks & Regards,', NULL, NULL, '2021-10-18 09:54:59', '2021-10-18 09:54:59'),
(21482, 10057, 21952, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center || Superior Health Plan || ref# 44237  Hello Veronica,  Hope this email finds you in good health. Can you please check the below mentioned remaining providers status along with the facility group contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Joseph, Molly - NUCC - IVUC - LPMC	1396380077 PAUL, SIGI - IVUC - LPMC	1033623616 Jacob, Jaya - IVUC - LPMC	1194336149  Kindly get back to me as soon as you get a chance.  Thanks & Regards,', NULL, NULL, '2021-11-22 11:41:27', '2021-11-22 11:41:27'),
(21483, 10057, 21952, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : RE: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Your email was received. An Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Case #69503 for Normandy Urgent Care Center and #69505 for Longpoint Medical Center.   Thank you,  Lionel Negrete Provider Account Manager', NULL, NULL, '2021-11-23 10:07:11', '2021-11-23 10:07:11'),
(21484, 10057, 21952, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : Enrollment Status || NUCC, IVUC & LPMC || Group & Providers || Ambetter ||  Hello,  Can I get the update on provider Sigi Paul & Molly Joseph enrollment status?  Please get back to me as soon as possible. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-03 15:57:02', '2021-12-03 15:57:02'),
(21485, 10057, 21952, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Called to check the status: 800-656-4817. Still in the process.  Need to check after 10 days.  Call Reference - 71689 - TIM', NULL, NULL, '2021-12-10 14:55:36', '2021-12-10 14:55:36'),
(21486, 10057, 21952, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Will Follow-up in Next Week.  Please see previous Call Comments. Thank you', NULL, NULL, '2021-12-17 10:59:52', '2021-12-17 10:59:52'),
(21487, 10057, 21952, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Hello Steve,  I hope this message finds you well.  Please find below the information requested.  Group Name:  NORMANDY URGENT CARE CENTER PA  TIN:  270796429  Provider(s):   MOLLY JOSEPH, NPI:  1396380077, contract status- pending completion.  Tentative effective date:  01/01/2022 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  09/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  10/01/2021  Group Name:  LONG POINT MEDICAL CENTER  TIN:  760612416  MOLLY JOSEPH, NPI:  1396380077, contract complete.  Effective date:  07/01/2021 SIGI PAUL, NPI:  1033623616, contract complete.  Effective date:  07/01/2021 JAYA JACOB, NPI:  1194336149, contract complete.  Effective date:  07/01/2021.  Happy Holidays.  Thank you, Yvette Hernandez', NULL, NULL, '2021-12-23 10:54:38', '2021-12-23 10:54:38'),
(21488, 10057, 21952, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : AM.Houston@superiorhealthplan.com  Sub : [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Thank you for your response Yvette. Is there any way that I can get welcome letters for all of them?  I really appreciate your kind assistance. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:18:22', '2021-12-30 13:18:22'),
(21489, 19067, 21952, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.Houston@superiorhealthplan.com  Subject: Re: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505     Good afternoon Steve,     Thank you for your email. Unfortunately, our department does not disperses Welcome Letters for providers.     I have sent our ECM team with your request to have welcome letters be issued out to you. Please await on a response from them with letters requested.    Thank you,   Yesenia Prado  Provider Account Manager  Nueces, Harris & Jefferson SDA', NULL, NULL, '2022-01-03 17:47:29', '2022-01-03 17:47:29'),
(21490, 20067, 21952, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@SuperiorHealthPlan.com  Sub: Fwd: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good afternoon,  Hope this email finds you well.Any update on the previously mentioned request.  Thanks and regards Syed Ahad. ', NULL, NULL, '2022-01-12 15:23:16', '2022-01-12 15:23:16'),
(21491, 20067, 21952, NULL, '2022-01-27 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Enrollment Status || Longpoint Medical Center || Group & Providers || Superior Health  Good Morning! Hope this email finds you in good health. I would like to know the enrollment status of the following providers and if they are enrolled kindly resend the welcome letters or request your ECM team to resend the letters.  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1771763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226 Provider Name	NPI SIGI PAUL	1033623616 Jaya Jacob	1194336149  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-20 12:25:20', '2022-01-20 12:25:20'),
(21492, 20067, 21952, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: RE: [Secure] Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center REF#69503 and REF#69505  Good Morning!  I would like to know the effective date of the below mentioned Groups and Providers. Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jaya Jacob	1194336149 SIGI PAUL	1033623616  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:28:04', '2022-01-28 11:28:04'),
(21493, 20067, 21952, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub:  Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-02-21 15:02:25', '2022-02-21 15:02:25'),
(21494, 20067, 21952, NULL, '2022-03-15 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com, shp-networkdevelopment@superiorhealthplan.com  Sub: Re: Enrollment Status ||  Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Evening!  I would like to know the status of the below-mentioned group and providers,  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Sigi Paul	1033623616 Jaya Jacob	1194336149  Thank you,', NULL, NULL, '2022-03-08 17:32:43', '2022-03-08 17:32:43'),
(21495, 20067, 21952, NULL, '2022-03-21 00:00:00.000', 'In Process', 'Email received from: credentialing@superiorhealthplan.com  Sub: Enrollment Status || Sigi Paul- Jaya Jacob & Group || Longpoint Mdical Center || Superior Health  Good Afternoon,        Sigi Paul, NP Individual NPI 1033623616 has a status of Make Par which means the file has moved to the department who completes the loading of the provider.  Superior HealthPlan Account Management can confirm plan effective date and participation status.     We do not show that we have received a request to credential Jaya Jacob NPI 1194336149.  Have you submitted a request for the provider to be added to the group.                    Group Name  Longpoint Medical Center  Tax ID  76-0612416  Group NPI  1770763815  Practice Location  9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name  NPI  Sigi Paul  1033623616  Jaya Jacob  1194336149     Thank You,', NULL, NULL, '2022-03-14 15:19:22', '2022-03-14 15:19:22'),
(21496, 3040, 21953, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:27:49', '2021-03-16 12:27:49'),
(21497, 3040, 21953, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:02', '2021-05-31 15:49:02'),
(21498, 3040, 21953, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:23', '2021-06-17 12:21:23'),
(21499, 3040, 21953, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:11', '2021-07-06 13:39:11'),
(21500, 3040, 21953, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:40', '2021-07-06 13:42:40'),
(21501, 3040, 21953, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:12', '2021-07-26 16:39:12'),
(21502, 11056, 21953, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:32:01', '2021-08-13 15:32:01'),
(21503, 3040, 21953, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:45', '2021-08-26 08:45:45'),
(21504, 10057, 21953, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:55:32', '2021-10-08 13:55:32'),
(21505, 10057, 21953, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:30', '2021-10-21 11:03:30'),
(21506, 10057, 21953, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:33', '2021-10-29 09:47:33'),
(21507, 10057, 21953, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:42:11', '2021-11-22 13:42:11'),
(21508, 10057, 21953, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:33:14', '2021-12-02 14:33:14'),
(21509, 10057, 21953, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:51', '2021-12-09 11:54:51'),
(21510, 10057, 21953, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:34', '2021-12-16 14:57:34'),
(21511, 10057, 21953, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:57', '2021-12-22 13:50:57'),
(21512, 10057, 21953, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:13', '2021-12-29 12:05:13'),
(21513, 20067, 21953, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:30', '2022-01-12 15:01:30'),
(21514, 20067, 21953, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:49', '2022-01-19 09:58:49'),
(21515, 20067, 21953, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:44:05', '2022-01-28 14:44:05'),
(21516, 3040, 21954, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:27:59', '2021-03-16 12:27:59'),
(21517, 3040, 21954, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:06', '2021-05-31 15:49:06'),
(21518, 3040, 21954, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:23', '2021-06-17 12:21:23'),
(21519, 3040, 21954, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:08', '2021-07-06 13:39:08');
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
(21520, 3040, 21954, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:40', '2021-07-06 13:42:40'),
(21521, 3040, 21954, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:12', '2021-07-26 16:39:12'),
(21522, 11056, 21954, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:53', '2021-08-13 15:31:53'),
(21523, 3040, 21954, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:45', '2021-08-26 08:45:45'),
(21524, 10057, 21954, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:55:22', '2021-10-08 13:55:22'),
(21525, 10057, 21954, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:23', '2021-10-21 11:03:23'),
(21526, 10057, 21954, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:27', '2021-10-29 09:47:27'),
(21527, 10057, 21954, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:42:05', '2021-11-22 13:42:05'),
(21528, 10057, 21954, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:33:07', '2021-12-02 14:33:07'),
(21529, 10057, 21954, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:44', '2021-12-09 11:54:44'),
(21530, 10057, 21954, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:28', '2021-12-16 14:57:28'),
(21531, 10057, 21954, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:50', '2021-12-22 13:50:50'),
(21532, 10057, 21954, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:06', '2021-12-29 12:05:06'),
(21533, 20067, 21954, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:24', '2022-01-12 15:01:24'),
(21534, 20067, 21954, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:43', '2022-01-19 09:58:43'),
(21535, 20067, 21954, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:43:59', '2022-01-28 14:43:59'),
(21536, 3040, 21955, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:28:18', '2021-03-16 12:28:18'),
(21537, 3040, 21955, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:09', '2021-05-31 15:49:09'),
(21538, 3040, 21955, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:17', '2021-06-17 12:21:17'),
(21539, 3040, 21955, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:05', '2021-07-06 13:39:05'),
(21540, 3040, 21955, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:39', '2021-07-06 13:42:39'),
(21541, 3040, 21955, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:11', '2021-07-26 16:39:11'),
(21542, 11056, 21955, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:46', '2021-08-13 15:31:46'),
(21543, 3040, 21955, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:44', '2021-08-26 08:45:44'),
(21544, 10057, 21955, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:55:11', '2021-10-08 13:55:11'),
(21545, 10057, 21955, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:17', '2021-10-21 11:03:17'),
(21546, 10057, 21955, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:21', '2021-10-29 09:47:21'),
(21547, 10057, 21955, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:41:58', '2021-11-22 13:41:58'),
(21548, 10057, 21955, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:32:31', '2021-12-02 14:32:31'),
(21549, 10057, 21955, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:38', '2021-12-09 11:54:38'),
(21550, 10057, 21955, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:22', '2021-12-16 14:57:22'),
(21551, 10057, 21955, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:44', '2021-12-22 13:50:44'),
(21552, 10057, 21955, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:05:00', '2021-12-29 12:05:00'),
(21553, 20067, 21955, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:01:17', '2022-01-12 15:01:17'),
(21554, 20067, 21955, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:37', '2022-01-19 09:58:37'),
(21555, 20067, 21955, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:43:53', '2022-01-28 14:43:53'),
(21556, 3040, 21956, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:28:45', '2021-03-16 12:28:45'),
(21557, 3040, 21956, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: axhartma@texaschildrens.org  Subject: TCHP Welcome Letter - Mini P. Chennemkara, FNP-C - Normandy Urgent Care Center PA - 3 Houston Addresses  Good Evening,  Welcome to TCHP. Mini P. Chennemkara, FNP-C is now participating with Texas Children’s Health Plan under Normandy Urgent Care Center PA at Normandy St, Imperial Valley Dr., and Long Pointe Rd . Attached you will find a welcome letter with an effective date for all contracted products as well as the contact information for your Provider Relations Representative.  Please reach out to your PR Rep or the main Contracting Department phone line at (832) 828-1063 with any questions.  Thank you,', NULL, NULL, '2021-05-04 08:35:47', '2021-05-04 08:35:47'),
(21558, 3040, 21957, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:29:07', '2021-03-16 12:29:07'),
(21559, 3040, 21957, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:13', '2021-05-31 15:49:13'),
(21560, 3040, 21957, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:14', '2021-06-17 12:21:14'),
(21561, 3040, 21957, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:03', '2021-07-06 13:39:03'),
(21562, 3040, 21957, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:38', '2021-07-06 13:42:38'),
(21563, 3040, 21957, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:10', '2021-07-26 16:39:10'),
(21564, 11056, 21957, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:41', '2021-08-13 15:31:41'),
(21565, 3040, 21957, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:44', '2021-08-26 08:45:44'),
(21566, 10057, 21957, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:54:45', '2021-10-08 13:54:45'),
(21567, 10057, 21957, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:03:10', '2021-10-21 11:03:10'),
(21568, 10057, 21957, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:14', '2021-10-29 09:47:14'),
(21569, 10057, 21957, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:41:51', '2021-11-22 13:41:51'),
(21570, 10057, 21957, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:32:25', '2021-12-02 14:32:25'),
(21571, 10057, 21957, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:32', '2021-12-09 11:54:32'),
(21572, 10057, 21957, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:16', '2021-12-16 14:57:16'),
(21573, 10057, 21957, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:38', '2021-12-22 13:50:38'),
(21574, 10057, 21957, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:54', '2021-12-29 12:04:54'),
(21575, 20067, 21957, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:00:36', '2022-01-12 15:00:36'),
(21576, 20067, 21957, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:31', '2022-01-19 09:58:31'),
(21577, 20067, 21957, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:43:47', '2022-01-28 14:43:47'),
(21578, 3040, 21958, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:29:22', '2021-03-16 12:29:22'),
(21579, 3040, 21958, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:17', '2021-05-31 15:49:17');
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
(21580, 3040, 21958, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:09', '2021-06-17 12:21:09'),
(21581, 3040, 21958, NULL, '2021-07-13 00:00:00.000', 'Approved', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:39:01', '2021-07-06 13:39:01'),
(21582, 3040, 21958, NULL, '2021-07-13 00:00:00.000', 'Revalidation', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:37', '2021-07-06 13:42:37'),
(21583, 3040, 21958, NULL, '2021-08-02 00:00:00.000', 'Revalidation', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:10', '2021-07-26 16:39:10'),
(21584, 3040, 21958, NULL, '2021-09-02 00:00:00.000', 'Revalidation', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:43', '2021-08-26 08:45:43'),
(21585, 10057, 21958, NULL, '2021-11-09 00:00:00.000', 'Revalidation', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-11-02 13:58:27', '2021-11-02 13:58:27'),
(21586, 10057, 21958, NULL, '2021-11-30 00:00:00.000', 'Revalidation', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-23 16:23:17', '2021-11-23 16:23:17'),
(21587, 10057, 21958, NULL, '2021-12-09 00:00:00.000', 'Revalidation', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:32:19', '2021-12-02 14:32:19'),
(21588, 10057, 21958, NULL, '2021-12-16 00:00:00.000', 'Revalidation', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:26', '2021-12-09 11:54:26'),
(21589, 10057, 21958, NULL, '2021-12-23 00:00:00.000', 'Revalidation', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:10', '2021-12-16 14:57:10'),
(21590, 10057, 21958, NULL, '2021-12-29 00:00:00.000', 'Revalidation', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:32', '2021-12-22 13:50:32'),
(21591, 10057, 21958, NULL, '2022-01-05 00:00:00.000', 'Revalidation', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:50', '2021-12-29 12:04:50'),
(21592, 20067, 21958, NULL, '2022-01-25 00:00:00.000', 'Revalidation', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-18 10:16:40', '2022-01-18 10:16:40'),
(21593, 20067, 21958, NULL, '2022-01-26 00:00:00.000', 'Revalidation', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:25', '2022-01-19 09:58:25'),
(21594, 20067, 21958, NULL, '2022-02-04 00:00:00.000', 'Revalidation', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:39', '2022-01-28 14:42:39'),
(21595, 3040, 21959, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:29:53', '2021-03-16 12:29:53'),
(21596, 3040, 21959, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:20', '2021-05-31 15:49:20'),
(21597, 3040, 21959, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:06', '2021-06-17 12:21:06'),
(21598, 3040, 21959, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:58', '2021-07-06 13:38:58'),
(21599, 3040, 21959, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:34', '2021-07-06 13:42:34'),
(21600, 3040, 21959, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:09', '2021-07-26 16:39:09'),
(21601, 11056, 21959, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:34', '2021-08-13 15:31:34'),
(21602, 3040, 21959, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you, Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim Kim', NULL, NULL, '2021-08-26 08:45:43', '2021-08-26 08:45:43'),
(21603, 10057, 21959, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:54:22', '2021-10-08 13:54:22'),
(21604, 10057, 21959, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:02:29', '2021-10-21 11:02:29'),
(21605, 10057, 21959, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:07', '2021-10-29 09:47:07'),
(21606, 10057, 21959, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:41:23', '2021-11-22 13:41:23'),
(21607, 10057, 21959, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:31:00', '2021-12-02 14:31:00'),
(21608, 10057, 21959, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:21', '2021-12-09 11:54:21'),
(21609, 10057, 21959, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:57:05', '2021-12-16 14:57:05'),
(21610, 10057, 21959, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:28', '2021-12-22 13:50:28'),
(21611, 10057, 21959, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:45', '2021-12-29 12:04:45'),
(21612, 20067, 21959, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:00:14', '2022-01-12 15:00:14'),
(21613, 20067, 21959, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:20', '2022-01-19 09:58:20'),
(21614, 20067, 21959, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:33', '2022-01-28 14:42:33'),
(21615, 3040, 21960, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:02', '2021-03-16 12:30:02'),
(21616, 1005, 21960, 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 12:59:42', '2021-06-01 12:59:42'),
(21617, 3040, 21960, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:55', '2021-07-06 13:38:55'),
(21618, 3040, 21960, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:34', '2021-07-06 13:42:34'),
(21619, 3040, 21960, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:09', '2021-07-26 16:39:09'),
(21620, 11056, 21960, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:18', '2021-08-13 15:31:18'),
(21621, 3040, 21960, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:43', '2021-08-26 08:45:43'),
(21622, 10057, 21960, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:54:15', '2021-10-08 13:54:15'),
(21623, 10057, 21960, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:02:22', '2021-10-21 11:02:22'),
(21624, 10057, 21960, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:47:00', '2021-10-29 09:47:00'),
(21625, 3040, 21961, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:18', '2021-03-16 12:30:18'),
(21626, 3040, 21961, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:24', '2021-05-31 15:49:24'),
(21627, 3040, 21961, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:03', '2021-06-17 12:21:03'),
(21628, 3040, 21961, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:53', '2021-07-06 13:38:53'),
(21629, 3040, 21961, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:33', '2021-07-06 13:42:33'),
(21630, 3040, 21961, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:08', '2021-07-26 16:39:08'),
(21631, 11056, 21961, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:11', '2021-08-13 15:31:11'),
(21632, 3040, 21961, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:42', '2021-08-26 08:45:42'),
(21633, 10057, 21961, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:54:06', '2021-10-08 13:54:06'),
(21634, 10057, 21961, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:02:15', '2021-10-21 11:02:15'),
(21635, 10057, 21961, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:46:52', '2021-10-29 09:46:52'),
(21636, 10057, 21961, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:41:15', '2021-11-22 13:41:15'),
(21637, 10057, 21961, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:30:54', '2021-12-02 14:30:54'),
(21638, 10057, 21961, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:15', '2021-12-09 11:54:15'),
(21639, 10057, 21961, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:56:58', '2021-12-16 14:56:58'),
(21640, 10057, 21961, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:23', '2021-12-22 13:50:23'),
(21641, 10057, 21961, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:41', '2021-12-29 12:04:41');
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
(21642, 20067, 21961, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:00:07', '2022-01-12 15:00:07'),
(21643, 20067, 21961, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:13', '2022-01-19 09:58:13'),
(21644, 20067, 21961, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:26', '2022-01-28 14:42:26'),
(21645, 3046, 21962, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:22', '2021-03-16 12:30:22'),
(21646, 3040, 21962, NULL, '2021-04-14 00:00:00.000', 'Initiated', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned practice and providers in Superior Health under the below location.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-07 13:51:18', '2021-04-07 13:51:18'),
(21647, 9057, 21962, NULL, '2021-06-03 00:00:00.000', 'In Process', 'We sent an email to:  AM.CorpusChristi@superiorhealthplan.com Sub:Group & Provider Enrollment || Statcare Minor Emergency Clinic || Group & Providers || Superior Health ||  Hello, We submitted a request to enroll our providers under the following group.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider 2: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider 3: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider 4: Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider 5: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Provider 6: Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 8: Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider 9: Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider 10: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Kindly update us on the status regarding the above mentioned request.  Thank you  ', NULL, NULL, '2021-05-26 14:59:04', '2021-05-26 14:59:04'),
(21648, 1006, 21962, NULL, '2021-06-22 00:00:00.000', 'On Hold', 'Ancillary enrollment is in process in the main group task. Please check the main group task for reference. ', NULL, NULL, '2021-06-15 17:08:02', '2021-06-15 17:08:02'),
(21649, 1006, 21962, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Contract received from Zujey Ashbaugh ZASHBAUGH@centene.com:  Sub: Signature requested on \"RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032\"  \"You finished signing “RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC ecm 547032”.  Next, SHP Provider Validation will approve.  We will email the final agreement to all parties. You can alsodownload a copyof what you just signed.\"  Copy of contract is attached in main Superior task for reference.  ', NULL, NULL, '2021-07-20 10:30:04', '2021-07-20 10:30:04'),
(21650, 1006, 21962, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Sent email @ AM.CorpusChristi@superiorhealthplan.com:  Sub: Enrollment Status - RHC - Superior Health  \"Hello,   I wanted to get an update regarding the enrollment status for the following group:  Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 TIN# 46-0575924  Primary Address: 500 E CAESAR, KINGSVILLE, TX 78363 Secondary Address: 6646 S. Staples St. # 122, Corpus Christi, TX 78413 Tertiary Address: 4042 River Hill, Corpus Christi, TX 78410 Quaternary Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-08-17 17:00:23', '2021-08-17 17:00:23'),
(21651, 1006, 21962, NULL, '2021-09-08 00:00:00.000', 'In Process', 'We received the following email from Zujey.Ashbaugh@superiorhealthplan.com:  \"Good afternoon,  We are still pending your completed credentialing documents. The contract was sign.  I have attached them for you. Once completed please forward them to SHP.NetworkDevelopment@superiorhealthplan.com  Thank you, Zujey Ashbaugh (Zuzy) Contract Coordinator Network Participation Request related info Phone Number 866-615-9399  “Never stop learning, because life never stops teaching”\"  Facility credentialing application was filled out and sent out to SHP.NetworkDevelopment@superiorhealthplan.com, attached in main group task for reference. ', NULL, NULL, '2021-09-01 15:30:20', '2021-09-01 15:30:20'),
(21652, 11056, 21962, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:07:32', '2021-09-22 12:07:32'),
(21653, 11056, 21962, NULL, '2021-09-29 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status - RHC - Superior Health  Good morning Brad  Happy Wednesday  Here is the information you requested for the following  RABAGOS HEALTH CARE PLLC dba STATCARE MINOR EMERGENCY CLINIC NPI#1689924904 under TID#460575924- per review the Network Development and Credentialing Team are awaiting response form the Provider. The application packet was sent back on 7/7/2021. Please respond to the Team as soon as you can, this can delay the credentialing process.  Have a great rest of the week and be safe  Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs  711 N. Carancahua Street, Suite 600 Corpus Christi, Texas 78401 Fax: (866) 683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthPlan.com Provider Relations Dept. 1-800-656-4817 Option 3 ', NULL, NULL, '2021-09-22 12:08:14', '2021-09-22 12:08:14'),
(21654, 11056, 21962, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:12', '2021-09-29 17:10:12'),
(21655, 11056, 21962, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good morning!  Hope this email finds you well. Please provide me with the latest updates regarding the enrollment process and with facility Ancillary application of which we have submitted in the starting of Sep,2021 of the Facility mentioned below:  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR, KINGSVILLE , TX 78363 Secondary Location	6646 S. Staples St. # 122, Corpus Christi , TX 78413 Tertiary Location	4042 River Hill, Corpus Christi , TX 78410 Quarternary Location	                3817 South Padre Island Drive, Corpus Christi , TX 78415   If you have any concerns or questions or require documents please let me know.   Thank you! Have a blessed week ahead!', NULL, NULL, '2021-09-29 17:10:12', '2021-09-29 17:10:12'),
(21656, 11056, 21962, NULL, '2021-10-19 00:00:00.000', 'In Process', 'Email received from : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning,   We received your completed application on 9/7/21. Your projected effective date is 10/01/21.  The enrollment record is currently in the process of being loaded into our system. Upon completion of this provider\'s enrollment, your agreement will be executed and welcome packet will be sent.', NULL, NULL, '2021-10-12 14:22:31', '2021-10-12 14:22:31'),
(21657, 11056, 21962, NULL, '2021-10-27 00:00:00.000', 'In Process', 'Email sent to : Zujey.Ashbaugh@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good evening Zujey!  Hope this email finds you well. It is just a follow up email regarding the agreement and welcome packet. I am still waiting for that, please provide that soon.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you!', NULL, NULL, '2021-10-20 12:50:29', '2021-10-20 12:50:29'),
(21658, 11056, 21962, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email received from: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub : Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Hello,     Your record has not been complete, but the effective date is still showing 10/1/121.     Once they complete your record. You will received a welcome packet.', NULL, NULL, '2021-11-10 17:25:27', '2021-11-10 17:25:27'),
(21659, 11056, 21962, NULL, '2021-11-26 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare   Good afternoon!  Hope this email finds you well. Has my record been completed yet or not? Please expedite, it has been a long time for the credentialing processing.  Take Care!  Thank you! Have a blessed day!', NULL, NULL, '2021-11-19 17:35:13', '2021-11-19 17:35:13'),
(21660, 11056, 21962, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email sent to:  SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub:  Enrollment Status Query || Statcare Minor Emergency Clinic || Wellcare  Good morning!  Hope this email finds you well. Please respond to my query at your earliest opportunity.  Eagerly, waiting for your reply.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-01 12:49:30', '2021-12-01 12:49:30'),
(21661, 11056, 21962, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: SHPNetwork.DevelopmentNPRContracting@superiorhealthplan.com  Sub: TO ADD LOCATION  Good afternoon!  Hope you are having a productive day. I am unable to add the location through the link. Kindly add the highlighted locations to the agreement and as well as to the directory too.  Group Name	Statcare Minor Emergency Clinic Tax ID	46-0575924 Group NPI	1689924904 Primary Location	500 E CAESAR KINGSVILLE, TX 78363 Secondary Location	6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location	4042 River Hill Corpus Christi, TX 78410 Quarternary Location	3817 South Padre Island Drive Corpus Christi, TX 78415 Quinary Location	2102 FM 2165, Rockport, TX 78382   Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-16 16:38:01', '2021-12-16 16:38:01'),
(21662, 11056, 21962, NULL, '2021-12-27 00:00:00.000', 'Approved', 'Email received from: ECME...@superiorhealthplan.com  Sub: [SECURE] RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC /AGREEMENT & WELCOME LETTER  RABAGOS HEALTH CARE PLLC dba STAT CARE MINOR EMERGENCY CLINIC   Welcome to the Superior HealthPlan network. We are excited to have you as a partner of our growing network of high-quality health care professionals. You play a key role as we pursue our commitment to improve the health and well-being of the members we serve. Your records were reviewed and approved by our credentialing committee. You are now able to provide covered services to Superior members.    Your effective date is: 10/1/2021        Please see the attachment.', NULL, NULL, '2021-12-20 14:56:21', '2021-12-20 14:56:21'),
(21663, 3040, 21963, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:27', '2021-03-16 12:30:27'),
(21664, 3040, 21963, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:27', '2021-05-31 15:49:27'),
(21665, 3040, 21963, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:21:00', '2021-06-17 12:21:00'),
(21666, 3040, 21963, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:51', '2021-07-06 13:38:51'),
(21667, 3040, 21963, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:32', '2021-07-06 13:42:32'),
(21668, 3040, 21963, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:07', '2021-07-26 16:39:07'),
(21669, 11056, 21963, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:31:02', '2021-08-13 15:31:02'),
(21670, 3040, 21963, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:42', '2021-08-26 08:45:42'),
(21671, 10057, 21963, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:53:17', '2021-10-08 13:53:17'),
(21672, 10057, 21963, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:02:08', '2021-10-21 11:02:08'),
(21673, 10057, 21963, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:46:45', '2021-10-29 09:46:45'),
(21674, 10057, 21963, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:40:21', '2021-11-22 13:40:21'),
(21675, 10057, 21963, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:30:49', '2021-12-02 14:30:49'),
(21676, 10057, 21963, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:10', '2021-12-09 11:54:10'),
(21677, 10057, 21963, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:56:52', '2021-12-16 14:56:52'),
(21678, 10057, 21963, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:16', '2021-12-22 13:50:16'),
(21679, 10057, 21963, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:36', '2021-12-29 12:04:36'),
(21680, 20067, 21963, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:00:01', '2022-01-12 15:00:01'),
(21681, 20067, 21963, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:07', '2022-01-19 09:58:07'),
(21682, 20067, 21963, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:20', '2022-01-28 14:42:20'),
(21683, 3040, 21964, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:35', '2021-03-16 12:30:35'),
(21684, 3040, 21964, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: axhartma@texaschildrens.org   Subject: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 15:49:31', '2021-05-31 15:49:31'),
(21685, 3040, 21964, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name:Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks ', NULL, NULL, '2021-06-17 12:20:57', '2021-06-17 12:20:57'),
(21686, 3040, 21964, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email rcvd from: tchpnetworkmanagement@texaschildrens.org  Subject; Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Normandy Urgent Care Center  Imperial Valley Urgent Care Center  Longpoint Medical Center  Are these groups in our network? If so, please reach out to you PR.  Thank you', NULL, NULL, '2021-07-06 13:38:49', '2021-07-06 13:38:49'),
(21687, 3040, 21964, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject:Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. I called the above number that you sent to find out if the above groups are in-network with TCHP or not. I am unable to find out the information because the provider relations department is not available over the phone. Can you please advise me if there is any other way I can find out the information.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-06 13:42:32', '2021-07-06 13:42:32'),
(21688, 3040, 21964, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: tchpnetworkmanagement@texaschildrens.org  Subject: Re: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,   I am still waiting for the PR contact information. Can you please forward it to me so I can contact the PR directly because our claims are getting denied by insurance.   Please look into this matter personally so we are able to resolve the issue. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-26 16:39:07', '2021-07-26 16:39:07'),
(21689, 11056, 21964, NULL, '2021-08-21 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: FW: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello PR,  Group Normandy Urgent Care Center, would like to know who is their group PR.  Thank you', NULL, NULL, '2021-08-13 15:30:47', '2021-08-13 15:30:47'),
(21690, 3040, 21964, NULL, '2021-09-02 00:00:00.000', 'In Process', 'Email rcvd from: kdelam@texaschildrens.org  Subject: Provider Contracts  Hello Adil,  Attached is the Provider Information Form to add locations and a Provider Information Change Form changes to existing providers.  I have included a breakdown of the contracts under your TIN.  Please contact me directly if you have any concerns getting the additional updates needed from contracting.     Thank you,  Kim', NULL, NULL, '2021-08-26 08:45:41', '2021-08-26 08:45:41'),
(21691, 10057, 21964, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Subject : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Good Afternoon,  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned group and providers in Texas Children Health Plan for our group under the below locations.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI George, Jeemo	1497219067 Jose, Julie	1447883061 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 Abraham, Glory	1194206490 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Abraham, Jeena	1467901587 PAUL, SIGI	1033623616 Joseph, Molly	1073019493 Jacob, Jaya	1194336149  Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-08 13:53:09', '2021-10-08 13:53:09'),
(21692, 10057, 21964, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org, kdelam@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Greetings!  Any update on below mentioned credentialing request?  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-10-21 11:02:00', '2021-10-21 11:02:00'),
(21693, 10057, 21964, NULL, '2021-11-05 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello Liz/Kimberly,  It should be Kimberly\'s responsibility to update you and us rather than we are trying to reach her or you for an application. Can someone please check that and respond. Thanks  Regards, Alex', NULL, NULL, '2021-10-29 09:46:38', '2021-10-29 09:46:38'),
(21694, 10057, 21964, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Hope you are doing well. Can I get the latest update on below mentioned providers enrollment status and facility contracts / agreements.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Joseph, Molly	1396380077 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Piccione JR, James M	1356321509 Jacob, Jaya	1194336149 PAUL, SIGI	1033623616 Fernandus, Limy	1972005189 Abraham, Jeena	1467901587 Chennemkara, Mini Philip	1841755956 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Brown, Brittany	1275163537 George, Jeemol	1497219067 Jose, Julie	1447883061  Kindly get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 13:40:04', '2021-11-22 13:40:04'),
(21695, 10057, 21964, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  Sure, for each provider please provide the date their application was submitted and which application did you submit (LOI or PIF).  Thank you', NULL, NULL, '2021-12-02 14:30:43', '2021-12-02 14:30:43'),
(21696, 10057, 21964, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. The person before me has resigned. I can see that he has submitted the LOI forms for those providers which are already approved.  Please check from your side which providers are enrolled and updated in the system. Rest let me know so I can submit the application again.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-09 11:54:04', '2021-12-09 11:54:04'),
(21697, 10057, 21964, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  I can provide status on application.  To check which providers are in network or not, please reach out to your PR.  They should be able to provide you with a roster for the group.  Thank you  -Liz', NULL, NULL, '2021-12-16 14:56:46', '2021-12-16 14:56:46'),
(21698, 10057, 21964, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Thank you for reaching out. Could you please provide me with the PR details. It will be highly appreciated.  Regards,', NULL, NULL, '2021-12-22 13:50:10', '2021-12-22 13:50:10'),
(21699, 10057, 21964, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : tchpnetworkmanagement@texaschildrens.org  Sub : Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||  Hello,  If your group is PAR, you can reach out to your PR at Provider Relations providerrelations@texaschildrens.org  If you are not in our network, reach out to provider assistance 832-828-1004.', NULL, NULL, '2021-12-29 12:04:31', '2021-12-29 12:04:31'),
(21700, 20067, 21964, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon,  Hope this email finds you well. I would like to know the enrollment status of the below-mentioned providers under these locations  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Molly Joseph	1396380077 Mini Chennemkara	1841755956 Odette Kourouma	1134525868 Ani Stephen	1588959118 James Piccione JR	1356321509 Jeny John	1073019493 Abdur Rauf	1497726202 Cini THomas	1134777238 James Piccione JR	1356321509 Vibitha Joseph	1952931560 SIGI PAUL	1033623616 Jeena Abraham	1467901587 Jaya Jacob	1194336149 Limy fernandus	1972005189 Brittany Brown	1275163537 Jeemol George	1497219067 Julie Jose	1447883061   Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-12 14:59:54', '2022-01-12 14:59:54'),
(21701, 20067, 21964, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org, tchpnetworkmanagement@texaschildrens.org   Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good Morning! Hope you are doing well. Any updates on the previous request?  Your Early response will be highly appreciated Thanks & Regards Syed Ahad.', NULL, NULL, '2022-01-19 09:58:01', '2022-01-19 09:58:01'),
(21702, 20067, 21964, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: providerrelations@texaschildrens.org  Sub: Re: Enrollment Status || Normandy Urgent Care Center, Imperial Valley Urgent Care Center & Longpoint Medical Center || Group & Providers || TCHP ||   Good afternoon!  Hope this email finds you in good health. I would like to know the enrollment status of the below-mentioned groups and providers. Thanks & Regards, Syed Ahad', NULL, NULL, '2022-01-28 14:42:12', '2022-01-28 14:42:12'),
(21703, 3046, 21965, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-16 12:30:37', '2021-03-16 12:30:37');
