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
(10592, 3040, 18675, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Hello,  Hope you are doing well. Please advise me the enrollment status for the below mentioned providers. I checked the provider directory and it only showed 02 providers only 02 locations not showing in McAllen location.   Moses Campos is not showing in the provider directory.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 14:01:57', '2021-03-08 14:01:57'),
(10593, 3040, 18675, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:56:50', '2021-03-15 17:56:50'),
(10594, 3040, 18675, NULL, '2021-04-19 00:00:00.000', 'Approved', 'Email rcvd from: txintaketeampiermailbox@bcbstx.com  Subject: BCBSTX New Provider Information  Group Name : VALLEY MED URGENT CARE PLLC Group Record Id : H000Q9Z701  Provider Name : MOSES CAMPOS Provider Record Number : H08NU75601 Specialty : Physician Assistant Effective Date: 03/15/2021', NULL, NULL, '2021-04-12 13:57:45', '2021-04-12 13:57:45'),
(10595, 3040, 18676, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 14:10:09', '2021-03-08 14:10:09'),
(10596, 3040, 18676, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 14:11:23', '2021-03-08 14:11:23'),
(10597, 3040, 18676, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:57:05', '2021-03-15 17:57:05'),
(10598, 3040, 18676, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:11', '2021-04-14 10:34:11'),
(10599, 3040, 18676, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:36:37', '2021-04-16 14:36:37'),
(10600, 3040, 18676, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:21', '2021-05-03 13:35:21'),
(10601, 3040, 18676, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:26', '2021-05-04 08:12:26'),
(10602, 3040, 18677, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 14:10:25', '2021-03-08 14:10:25'),
(10603, 3040, 18677, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to:  noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Re: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Greetings,   Please advise me the enrollment status for the below mentioned providers. As I mentioned in my previous email I checked BCBS online provider portal and now its showing the providers only at 01 location which is (2534 Boca Chica Blvd, Brownsville TX, 78521) the other 02 locations providers are not showing for your reference I attached the screenshot with the location zip code from the website.   Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Moses Campos Provider NPI# 1558680009 Provider Record ID# 8NU756  Provider 2: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757  Provider 3: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU758  Kindly back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you. ', NULL, NULL, '2021-03-08 14:11:08', '2021-03-08 14:11:08'),
(10604, 3040, 18677, NULL, '2021-03-22 00:00:00.000', 'In Process', 'Email sent to: noemi_martinez@bcbstx.com, provider_relations_south_texas@bcbstx.com, tx_standard_contracting_team@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-15 17:57:14', '2021-03-15 17:57:14'),
(10605, 3040, 18677, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Greetings,   Hope you are doing well. Please note the providers are not showing up in the BCBS provider directory in all three locations except (2534 Boca Chica Blvd, Brownsville TX, 78521). Can you please advise how much time will it take to show up in the directory?  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice NPI# 1518404631 Practice Tax ID# 81-5123542 Primary Address: 534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd  Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    Please get back to me as soon as possible. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-04-14 10:34:18', '2021-04-14 10:34:18'),
(10606, 3040, 18677, NULL, '2021-04-23 00:00:00.000', 'In Process', 'Email rcvd From: Noemi_Diaz@bcbstx.com  Subject:  Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS || : Case Number - 02137524 : Case Number - 02160702  Good afternoon,  My apologies that the locations still aren’t showing up for the providers.  Let me see what I can find out for you.  Thank you,  ', NULL, NULL, '2021-04-16 14:36:50', '2021-04-16 14:36:50'),
(10607, 3040, 18677, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Email sent to: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Hello Noemi,  I checked the BCBS online provider directory and the providers are still not showing in other 02 locations. Can you please check and update.   Thank you ', NULL, NULL, '2021-05-03 13:35:27', '2021-05-03 13:35:27'),
(10608, 3040, 18677, NULL, '2021-05-11 00:00:00.000', 'Approved', 'Email rcvd from: Noemi_Diaz@bcbstx.com  Subject: Enrollment Status Update || Wright, Larry Donald, Campos, Moses, Lira, Arturo Alejandro || Valley Med Urgent Care PLLC || BCBS  Good afternoon,  The satellite locations have now been added to the providers.  Provider 1: Provider Name: Arturo Alejandro Lira Provider NPI# 1245789502 Provider Record ID#  8NU757 Effective Date:  03/04/2021  Provider 2: Provider Name: Larry Donald Wright Provider NPI# 1033769765 Provider Record ID# 8NU75 Effective Date:  03/03/2021    All the Best,', NULL, NULL, '2021-05-04 08:12:33', '2021-05-04 08:12:33'),
(10609, 3046, 18678, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 14:46:23', '2021-03-08 14:46:23'),
(10610, 3046, 18678, NULL, '2021-03-15 00:00:00.000', 'Initiated', 'Email from: matthew.hayes@centene.com Subject: contract and the data form  Good Afternoon Shazana,  Here is the contract and the data form. Please fill out a Practitioner data form for each doctor at the practice if there is more than one.  Thank you! Matthew Hayes Contract Negotiator', NULL, NULL, '2021-03-08 14:51:09', '2021-03-08 14:51:09'),
(10611, 3046, 18678, NULL, '2021-03-15 00:00:00.000', 'Initiated', 'Email to: matthew.hayes@centene.com Subject: Practitioner Data Form & Contract  Dear Mathew, Greetings,  Hope my email finds you well. As per your request, please find the practitioner data form enclosed with this email.  Thank you.   Please see the attachment.', NULL, NULL, '2021-03-08 14:56:13', '2021-03-08 14:56:13'),
(10612, 3046, 18678, NULL, '2021-03-16 00:00:00.000', 'In Process', 'Good Afternoon,     Thank you so much for your response! I am uploading this Contract to our coordinators now.  If we need anything else for credentialing purposes I will reach out!   Warm Regards,', NULL, NULL, '2021-03-09 17:44:51', '2021-03-09 17:44:51'),
(10613, 1005, 18678, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', 'Not working on this provider\'s credentialing anymore.', NULL, NULL, '2021-06-01 13:46:56', '2021-06-01 13:46:56'),
(10614, 3040, 18679, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:11:12', '2021-03-08 15:11:12'),
(10615, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:16:57', '2021-03-08 15:16:57'),
(10616, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:21', '2021-03-08 15:17:21'),
(10617, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:35', '2021-03-08 15:17:35'),
(10618, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: 	HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the update on the enrollment status of below mentioned providers. We already sent the credential application form for Moses Campos.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:54', '2021-03-08 15:17:54'),
(10619, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-08 15:18:09', '2021-03-08 15:18:09'),
(10620, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2021-03-08 15:18:24', '2021-03-08 15:18:24'),
(10621, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2021-03-08 15:18:39', '2021-03-08 15:18:39'),
(10622, 3040, 18679, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 15:18:55', '2021-03-08 15:18:55'),
(10623, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Need to check the contract status from Kmoten4@humana.com.', NULL, NULL, '2021-03-10 17:45:45', '2021-03-10 17:45:45'),
(10624, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-10 17:46:09', '2021-03-10 17:46:09'),
(10625, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-10 17:46:23', '2021-03-10 17:46:23'),
(10626, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-03-10 17:46:47', '2021-03-10 17:46:47'),
(10627, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-03-10 17:47:19', '2021-03-10 17:47:19'),
(10628, 3040, 18679, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-03-10 17:47:41', '2021-03-10 17:47:41'),
(10629, 3040, 18679, NULL, '2021-03-19 00:00:00.000', 'In Process', 'still in process ', NULL, NULL, '2021-03-12 17:22:00', '2021-03-12 17:22:00'),
(10630, 3040, 18679, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Provider enrolled in Tricare.   Please see attachment. ', NULL, NULL, '2021-03-18 08:59:24', '2021-03-18 08:59:24'),
(10631, 3040, 18680, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:11:13', '2021-03-08 15:11:13'),
(10632, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of the below mentioned provider. The two providers are already certified and the dates are mentioned below.  Practice Detail: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Can you please advise that did you received the credentialing application for below provider.  Provider 3: Provider Name: Wright, Larry Donald Provider NPI# 1033769765   Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:16:52', '2021-03-08 15:16:52'),
(10633, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com,   HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:16', '2021-03-08 15:17:16'),
(10634, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of this below mentioned provider.  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:30', '2021-03-08 15:17:30'),
(10635, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: 	HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the update on the enrollment status of below mentioned providers. We already sent the credential application form for Moses Campos.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:17:45', '2021-03-08 15:17:45'),
(10636, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.', NULL, NULL, '2021-03-08 15:18:03', '2021-03-08 15:18:03'),
(10637, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2021-03-08 15:18:19', '2021-03-08 15:18:19'),
(10638, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email received from: HGBProviderRosters@humana.com  Subject: Enrollment Status Update || Wright, Larry Donald || Valley Med Urgent Care PLLC || Tricare ||  Thank you for your roster submission!  Roster updates will be processed within 30 days of receipt and status responses that include loaded data and effective dates will be delivered upon completion.  Please note roster updates must include at minimum the following data elements in order for updates to be processed:  Name, NPI or SSN, Gender, Address, Specialty, Location or Practice Name, Phone Number, and Fax Number. Incomplete records will not be processed and will not be viewable on the online provider directory.', NULL, NULL, '2021-03-08 15:18:34', '2021-03-08 15:18:34'),
(10639, 3040, 18680, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 15:18:50', '2021-03-08 15:18:50'),
(10640, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Need to check the contract status from Kmoten4@humana.com.', NULL, NULL, '2021-03-10 17:45:46', '2021-03-10 17:45:46'),
(10641, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you are doing well. Please note the I checked the provider enrollment status on Tricare portal for below mentioned providers its shows the credentialing is completed but on Tricare provider directory its not showing up. Can you please check and advise.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Cynthia Rodriguez PA Provider NPI# 1124282553  Provider Name: Larry D Wright NP Provider NPI# 1033769765  Also I checked the provider enrollment status for the below mentioned provider its only showing in 02 locations in-process. In McAllen location provider is not showing up. Can you please check this and advise.   Provider Name: Deborah Potter NP Provider NPI# 1861914053  Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-10 17:46:05', '2021-03-10 17:46:05'),
(10642, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Has there been any update?  Thanks ', NULL, NULL, '2021-03-10 17:46:18', '2021-03-10 17:46:18'),
(10643, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  I hope you had a great weekend. Please advise me the status of the enrollment for the below mentioned providers.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765 ', NULL, NULL, '2021-03-10 17:46:42', '2021-03-10 17:46:42'),
(10644, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Follow up email sent to: KMoten4@humana.com, ywyatt@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. This is a follow up email regarding the location update for the below mentioned facility. We have an ancillary contract.    Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166    Please find below the providers are certified and advise me in which location they are coming up under.   Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible. Waiting for your response.  Thanks', NULL, NULL, '2021-03-10 17:47:14', '2021-03-10 17:47:14'),
(10645, 3040, 18680, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status and as well as the location update of the below mentioned providers.   I had a word with Tricare representative and she said the below mentioned providers are certified and already In-network with Tricare and we can start sending the billings. When I checked the online portal it was not showing me any information about the providers. For your convenience I mentioned the certified dates of the providers which I got from the Tricare representative.   Practice Details:  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166     Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502 Certified: 12/30/2020  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009 Certified: 11/3/2020  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553 Certified: 10/16/2020  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053 Certified: 11/04/2020  Can you please advise me if you received the credentialing application for the below provider.  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please get back to me as soon as possible.  Thanks', NULL, NULL, '2021-03-10 17:47:36', '2021-03-10 17:47:36'),
(10646, 3040, 18680, NULL, '2021-03-19 00:00:00.000', 'In Process', 'still in process ', NULL, NULL, '2021-03-12 17:22:07', '2021-03-12 17:22:07'),
(10647, 3040, 18680, NULL, '2021-03-25 00:00:00.000', 'Approved', 'Provider enrolled in Tricare.   Please see attachment. ', NULL, NULL, '2021-03-18 08:59:29', '2021-03-18 08:59:29'),
(10648, 3040, 18681, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:24:23', '2021-03-08 15:24:23'),
(10649, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.   The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review.', NULL, NULL, '2021-03-08 15:25:16', '2021-03-08 15:25:16'),
(10650, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review.', NULL, NULL, '2021-03-08 15:25:33', '2021-03-08 15:25:33'),
(10651, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to : kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||   Greetings,  Hope you are doing well.   I just wanted to know that Martin sent you the credential application form for Moses Campos on 11/16/2020. Kindly advise me the status of that request.   I really appreciate all your help. If you need further information kindly contact me or email me.   Thanks ', NULL, NULL, '2021-03-08 15:25:46', '2021-03-08 15:25:46'),
(10652, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Form request sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare |   Greetings,  Hope you doing well. We already sent the spreadsheet on the email that you provide.  Kindy send me the credentialing application form for Campos, Moses.  Please feel free to email me if you need anything else from my end. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:25:59', '2021-03-08 15:25:59'),
(10653, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:12', '2021-03-08 15:26:12'),
(10654, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:25', '2021-03-08 15:26:25'),
(10655, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:38', '2021-03-08 15:26:38'),
(10656, 3040, 18681, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 15:26:56', '2021-03-08 15:26:56'),
(10657, 3040, 18681, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:14', '2021-03-16 13:55:14'),
(10658, 3040, 18681, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:42', '2021-04-15 08:07:42'),
(10659, 3040, 18681, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009', NULL, NULL, '2021-04-15 10:26:43', '2021-04-15 10:26:43'),
(10660, 3040, 18682, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:24:24', '2021-03-08 15:24:24'),
(10661, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Still in process.   The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review.', NULL, NULL, '2021-03-08 15:25:10', '2021-03-08 15:25:10'),
(10662, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  The Application for Moses Campos was submitted on 12/18/2020 for processing. Please allow 90 days for review.', NULL, NULL, '2021-03-08 15:25:28', '2021-03-08 15:25:28'),
(10663, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to : kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||   Greetings,  Hope you are doing well.   I just wanted to know that Martin sent you the credential application form for Moses Campos on 11/16/2020. Kindly advise me the status of that request.   I really appreciate all your help. If you need further information kindly contact me or email me.   Thanks ', NULL, NULL, '2021-03-08 15:25:41', '2021-03-08 15:25:41'),
(10664, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Form request sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare |   Greetings,  Hope you doing well. We already sent the spreadsheet on the email that you provide.  Kindy send me the credentialing application form for Campos, Moses.  Please feel free to email me if you need anything else from my end. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:25:55', '2021-03-08 15:25:55'),
(10665, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:08', '2021-03-08 15:26:08'),
(10666, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:20', '2021-03-08 15:26:20');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10667, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Moses Campos.  Kindly advise me the time frame of enrollment process.  For further assistance please feel free to contact me. Looking forward to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:26:34', '2021-03-08 15:26:34'),
(10668, 3040, 18682, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Follow up email to : KMoten4@humana.com  Subject: Enrollment Status Update || Rodriguez, Cynthia, Wright, Larry Donald, Campos, Moses || Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. I want to know the enrollment status of  this below mentioned provider.   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Campos, Moses Provider NPI# 1558680009   Group Name: Valley Med Urgent Care (All three locations) Group Tax-ID: 81-5123542 Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Please feel free to email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-08 15:26:50', '2021-03-08 15:26:50'),
(10669, 3040, 18682, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 14:01:29', '2021-03-16 14:01:29'),
(10670, 3040, 18682, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:45', '2021-04-15 08:07:45'),
(10671, 3040, 18682, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 2: Provider Name: Campos, Moses - eff: 3/16/2021 (showing under all 3 locations) Provider NPI# 1558680009', NULL, NULL, '2021-04-15 10:26:47', '2021-04-15 10:26:47'),
(10672, 3040, 18683, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:28:24', '2021-03-08 15:28:24'),
(10673, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  This application has been submitted for processing, please allow 90 days for review.', NULL, NULL, '2021-03-08 15:29:27', '2021-03-08 15:29:27'),
(10674, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached the requested documents for Deborah Potter.  If you anything else please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:29:40', '2021-03-08 15:29:40'),
(10675, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Yes she is certified, but now she needs to be credentialed and I need all those documents to credential this provider with Humana Military.  Need to send the requested documents. Only Resume is missing. We already requested waiting for the email. ', NULL, NULL, '2021-03-08 15:29:53', '2021-03-08 15:29:53'),
(10676, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 15:30:06', '2021-03-08 15:30:06'),
(10677, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Please resubmit the application with all documents: CV, DEA, Malpractice Insurance, License, W9.', NULL, NULL, '2021-03-08 15:30:20', '2021-03-08 15:30:20'),
(10678, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:30:36', '2021-03-08 15:30:36'),
(10679, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-03-08 15:30:53', '2021-03-08 15:30:53'),
(10680, 3040, 18683, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-03-08 15:31:06', '2021-03-08 15:31:06'),
(10681, 3040, 18683, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:28', '2021-03-16 13:55:28'),
(10682, 3040, 18683, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:51', '2021-04-15 08:07:51'),
(10683, 3040, 18683, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 4: Provider Name: Potter, Deborah - eff: 4/13/2021 (showing under all 3 locations) Provider NPI# 1861914053 ', NULL, NULL, '2021-04-15 11:15:46', '2021-04-15 11:15:46'),
(10684, 3040, 18684, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 15:28:26', '2021-03-08 15:28:26'),
(10685, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  This application has been submitted for processing, please allow 90 days for review.', NULL, NULL, '2021-03-08 15:29:32', '2021-03-08 15:29:32'),
(10686, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find the attached the requested documents for Deborah Potter.  If you anything else please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:29:45', '2021-03-08 15:29:45'),
(10687, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Yes she is certified, but now she needs to be credentialed and I need all those documents to credential this provider with Humana Military.  Need to send the requested documents. Only Resume is missing. We already requested waiting for the email. ', NULL, NULL, '2021-03-08 15:29:58', '2021-03-08 15:29:58'),
(10688, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.   Thanks', NULL, NULL, '2021-03-08 15:30:10', '2021-03-08 15:30:10'),
(10689, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email rcvd from: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Please resubmit the application with all documents: CV, DEA, Malpractice Insurance, License, W9.', NULL, NULL, '2021-03-08 15:30:25', '2021-03-08 15:30:25'),
(10690, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  I hope you had a great weekend. I just wanted to know if Deborah Potter is certified?  The documents that you requested from me in your previous email are required for her credentialing process?  Please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-08 15:30:41', '2021-03-08 15:30:41'),
(10691, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: 	ywyatt@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-03-08 15:30:57', '2021-03-08 15:30:57'),
(10692, 3040, 18684, NULL, '2021-03-15 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enrollment Status Update || Potter, Deborah ||Valley Med Urgent Care PLLC || Tricare ||  Greetings,  Hope you are doing well. Please find in attached the provider credential application form for Potter Deborah.  Kindly advise me the time frame of the enrollment process.  For further assistance please feel free to contact me. Looking forward to hearing from you soon.  Thanks', NULL, NULL, '2021-03-08 15:31:10', '2021-03-08 15:31:10'),
(10693, 3040, 18684, NULL, '2021-03-23 00:00:00.000', 'In Process', 'Still in process. ', NULL, NULL, '2021-03-16 13:55:19', '2021-03-16 13:55:19'),
(10694, 3040, 18684, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Hello Katherine,  Hope you doing well. Please advise me the enrollment status for the below mentioned providers for our group Valley Med Urgent Care PLLC in all three locations.  Practice Details: Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 2: Provider Name: Campos, Moses Provider NPI# 1558680009  Provider 3: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 4: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 5: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-04-15 08:07:54', '2021-04-15 08:07:54'),
(10695, 3040, 18684, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Email rcvd from: KMoten4@humana.com  Subject: Enrollment & Location Update || Valley Med Urgent Care PLLC || Tricare ||  Provider 4: Provider Name: Potter, Deborah - eff: 4/13/2021 (showing under all 3 locations) Provider NPI# 1861914053 ', NULL, NULL, '2021-04-15 11:15:41', '2021-04-15 11:15:41'),
(10696, 3046, 18685, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-08 17:07:55', '2021-03-08 17:07:55'),
(10697, 3046, 18685, NULL, '2021-03-15 00:00:00.000', 'Initiated', 'Online Group Enrollment has been initiated.   Thank you for submitting the form.  Your case number:02275931  Your request may take up to 30 days to complete. Once completed, a notification will be sent to the email address submitted with the Demographic Change Request Form.', NULL, NULL, '2021-03-08 17:09:00', '2021-03-08 17:09:00'),
(10698, 3046, 18685, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com                           tx_standard_contracting_team@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Greetings, Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID: 46-0575924 Practice NPI:      1689924904  Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 10:10:56', '2021-03-18 10:10:56'),
(10699, 3040, 18685, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to; provider_relations_houston@bcbstx.com  Subject: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  Greetings,   Hope you are doing well. I wanted to add the group location in BCBS for our group Statcare Minor Emergency Clinic (SPID) under below locations.  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-29 11:08:41', '2021-03-29 11:08:41'),
(10700, 3040, 18685, NULL, '2021-04-06 00:00:00.000', 'In Process', 'Email sent to: Provider_Relations_South_Texas@bcbstx.com  Subject: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  Good Morning Connie,  Hope you are doing well. I wanted to add the group location in BCBS for our group Statcare Minor Emergency Clinic (SPID) under below locations.  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-03-30 08:30:35', '2021-03-30 08:30:35'),
(10701, 1006, 18685, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:08', '2021-04-15 08:43:08'),
(10702, 1006, 18685, NULL, '2021-05-04 00:00:00.000', 'Approved', 'Group contracted with BCBS.   Please see attachment.  ', NULL, NULL, '2021-04-27 08:13:30', '2021-04-27 08:13:30'),
(10703, 3046, 18686, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 09:49:00', '2021-03-09 09:49:00'),
(10704, 3046, 18686, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Email sent to:SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: new contract request  They would need to submit an application at https://swhp.org/forms/html/provider-account-request.html I will hold the NP application open for 2 weeks, to allow time for the Supervising Physician to apply. Thank you  Network Development  It has been initiated as it was required by Scott&White to enroll Katherine D Paterson  Success! Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 11f9c6ef-e908-4409-9ad5-f73d4e05fd29  ', NULL, NULL, '2021-03-09 09:55:23', '2021-03-09 09:55:23'),
(10705, 3046, 18686, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org Subject: New Contract Request  Hello, Hope my email finds you well. I would like to request you for the enrollment status for below mentioned provider:  Provider DetailsProvider  Name: Dehnisch, Frank R Provider NPI:     1952376345 Practice Details Practice Name: Coastal Bend Urgent Care Practice Tax ID: 81-1890349 Your quick response in this regard is highly appreciated. Thank you.', NULL, NULL, '2021-03-18 09:46:12', '2021-03-18 09:46:12'),
(10706, 1006, 18686, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following response from S&W:  \"Please allow 30 to 45 days for review of the initial application before requesting a status.  Thank you  Network Development  1206 West Campus Dr | MS-A4-126 | Temple, TX 76502 SWHPProviderNetworkDevelopment@bswhealth.org\"', NULL, NULL, '2021-03-22 09:32:09', '2021-03-22 09:32:09'),
(10707, 1006, 18686, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Received the following rejection letter from SWHP PROVIDER NETWORK DEVELOPMENT SWHPPROVIDERNETWORKDEVELOPMENT@bswhealth.org::  Sub: New Contract Request  \"Tax ID#: 81-1890349  RE: Network Denial  Dear Frank R Dehnisch  Thank you for your recent application.  Scott and White Health Plans (SWHP) and SHA, LLC dba FirstCare Health Plans (FirstCare) appreciates your interest in becoming a part of our network.  After reviewing your online application to contract submitted on 03/09/2021, SWHP and FirstCare regretfully declines to contract with Frank R Dehnisch this time. The determination was made based on our current network needs. However, we encourage you to reapply in 6 months; as those needs may change.   Thank you again for your interest in SWHP and FirstCare Health Plans.  Best Regards,  Scott and White Health Plans |SHA, LLC dba FirstCare Health Plans Network Development Department 1206 West Campus Dr. Temple, Texas 76502\"', NULL, NULL, '2021-05-18 14:04:49', '2021-05-18 14:04:49'),
(10708, 3046, 18687, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:08:54', '2021-03-09 14:08:54'),
(10709, 3046, 18687, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 02278580, for STATCARE MINOR EMERGENCY CLINIC.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-03-09 14:09:15', '2021-03-09 14:09:15'),
(10710, 3046, 18687, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com                           tx_standard_contracting_team@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Greetings, Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID: 46-0575924 Practice NPI:      1689924904  Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 10:10:58', '2021-03-18 10:10:58'),
(10711, 3046, 18687, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Received from: provider_relations_houston@bcbstx.com Hello Henry,  At this time I am not showing that this provider is attached to your tax id, you may reach out to your provider representative Connie to get specific information.  Her email is Connie_Traylor@bcbstx.com.  Thank you    Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Hello Connie,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:56:53', '2021-03-18 12:56:53'),
(10712, 3046, 18687, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Received from: provider_relations_houston@bcbstx.com Hello Henry,  At this time I am not showing that this provider is attached to your tax id, you may reach out to your provider representative Connie to get specific information.   Her email is Connie_Traylor@bcbstx.com.  Thank you    Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Hello Connie,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:57:21', '2021-03-18 12:57:21'),
(10713, 3046, 18687, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email from: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Good afternoon,  Rose Puentes Trevino does not have a provider ID number, or any locations tied to TIN 46-0575924 Thanks,  Connie Traylor Assoc Network Management Consultant Blue Cross and Blue Shield of Texas Lubbock, Texas 79424 Ph: 806-798-6317 Fax: 806-783-4666 Helpful Links: Availity -  800-282-4548 BCBSTX Provider Website -  http://www.bcbstx.com/provider/ Claims Adjustment -  800-451-0287 COVID-19/ Telehealth & Telemedicine - https://www.bcbstx.com/provider/covid-19-preparedness.html Provider Training -  https://www.bcbstx.com/provider/training/faqs.html  _____________________________________________________________________________________________________________________________________________ Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Dear Connie, Thank you for your prompt response. I would like to request you if you can check and advise the status of the case number 02306784  as we have initiated the request on 03/09/2021. Thank you', NULL, NULL, '2021-03-18 14:18:15', '2021-03-18 14:18:15'),
(10714, 3046, 18687, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status.', NULL, NULL, '2021-03-18 15:50:06', '2021-03-18 15:50:06'),
(10715, 1006, 18687, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Approval received from Sue Chang Sue_Chang@bcbstx.com & BCBS Texas txintaketeampiermailbox@bcbstx.com:  Sub: BCBSTX New Provider Information  \"Group Name : STATCARE MINOR EMERGENCY CLINIC  Group Record Id :  Provider Name : ROSE M PUENTES Provider Record Number : Specialty :  Networks : BAV, BCA, CHP, HME, HMO, PMC, SPL, STK, STR\"  Eff: 04/22/2021  Location confirmation and welcome letters are attached for reference.', NULL, NULL, '2021-04-21 15:44:44', '2021-04-21 15:44:44'),
(10716, 3046, 18688, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:09:32', '2021-03-09 14:09:32'),
(10717, 3046, 18688, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 02278580, for STATCARE MINOR EMERGENCY CLINIC.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-03-09 14:09:46', '2021-03-09 14:09:46'),
(10718, 3046, 18688, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com                           tx_standard_contracting_team@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Greetings, Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID: 46-0575924 Practice NPI:      1689924904  Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 10:10:51', '2021-03-18 10:10:51'),
(10719, 3046, 18688, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Received from: provider_relations_houston@bcbstx.com Hello Henry,  At this time I am not showing that this provider is attached to your tax id, you may reach out to your provider representative Connie to get specific information.   Her email is Connie_Traylor@bcbstx.com.  Thank you    Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Hello Connie,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:57:38', '2021-03-18 12:57:38'),
(10720, 3046, 18688, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status. ', NULL, NULL, '2021-03-18 15:52:50', '2021-03-18 15:52:50'),
(10721, 3046, 18688, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status.', NULL, NULL, '2021-03-18 15:53:41', '2021-03-18 15:53:41'),
(10722, 1006, 18688, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Approval received from Sue Chang Sue_Chang@bcbstx.com & BCBS Texas txintaketeampiermailbox@bcbstx.com:  Sub: BCBSTX New Provider Information  \"Group Name : STATCARE MINOR EMERGENCY CLINIC  Group Record Id :  Provider Name : ROSE M PUENTES Provider Record Number : Specialty :  Networks : BAV, BCA, CHP, HME, HMO, PMC, SPL, STK, STR\"  Eff: 04/22/2021  Location confirmation and welcome letters are attached for reference.', NULL, NULL, '2021-04-21 15:44:37', '2021-04-21 15:44:37'),
(10723, 3046, 18689, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:10:16', '2021-03-09 14:10:16'),
(10724, 3046, 18689, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 02278580, for STATCARE MINOR EMERGENCY CLINIC.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-03-09 14:10:32', '2021-03-09 14:10:32'),
(10725, 3046, 18689, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Greetings,   Hope you are doing well.   I would like to request you for the enrollment status for below mentioned provider:   Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794   Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415   Your quick response in this regard will be highly appreciated. Thank you.  ', NULL, NULL, '2021-03-18 12:39:54', '2021-03-18 12:39:54'),
(10726, 3046, 18689, NULL, '2021-03-25 00:00:00.000', 'New/Not Initiated', 'Email Received from: provider_relations_houston@bcbstx.com Hello Henry,  At this time I am not showing that this provider is attached to your tax id, you may reach out to your provider representative Connie to get specific information.   Her email is Connie_Traylor@bcbstx.com.  Thank you    Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Hello Connie,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:57:49', '2021-03-18 12:57:49'),
(10727, 3046, 18689, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status. ', NULL, NULL, '2021-03-18 15:53:26', '2021-03-18 15:53:26'),
(10728, 3046, 18689, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status.', NULL, NULL, '2021-03-18 15:53:56', '2021-03-18 15:53:56'),
(10729, 1006, 18689, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Sent f/u @ TX NM South Texas Provider_Relations_South_Texas@bcbstx.com: Sub: Add Group Location || Statcare Minor Emergency Clinic (SPID) || Group || BCBS ||  \"Hello,   I wanted to get an update regarding a demographic update request we submitted last month for the following group:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 168992490  Please get back to me as soon as you\'re able to.  Thanks.\"', NULL, NULL, '2021-04-15 08:43:14', '2021-04-15 08:43:14'),
(10730, 1006, 18689, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Approval received from Sue Chang Sue_Chang@bcbstx.com & BCBS Texas txintaketeampiermailbox@bcbstx.com:  Sub: BCBSTX New Provider Information  \"Group Name : STATCARE MINOR EMERGENCY CLINIC  Group Record Id :  Provider Name : ROSE M PUENTES Provider Record Number : Specialty :  Networks : BAV, BCA, CHP, HME, HMO, PMC, SPL, STK, STR\"  Eff: 04/22/2021  Location confirmation and welcome letters are attached for reference.', NULL, NULL, '2021-04-21 15:44:32', '2021-04-21 15:44:32'),
(10731, 3046, 18690, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:10:52', '2021-03-09 14:10:52'),
(10732, 3046, 18690, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Thank you for contacting Blue Cross and Blue Shield of Texas.  This email is confirmation we have received your request, case number 02278580, for STATCARE MINOR EMERGENCY CLINIC.  Your request may take up to 60-90 days to process. Once completed, a notification will be sent to the email address you provided during your submission.  To check the status of your case, please click on status checker or for any questions, please contact 1-877-229-0719.   Sincerely, Blue Cross and Blue Shield of Texas', NULL, NULL, '2021-03-09 14:11:05', '2021-03-09 14:11:05'),
(10733, 3046, 18690, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: provider_relations_houston@bcbstx.com                           tx_standard_contracting_team@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Greetings, Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID: 46-0575924 Practice NPI:      1689924904  Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 10:10:54', '2021-03-18 10:10:54'),
(10734, 3046, 18690, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email Received from: provider_relations_houston@bcbstx.com Hello Henry,  At this time I am not showing that this provider is attached to your tax id, you may reach out to your provider representative Connie to get specific information.   Her email is Connie_Traylor@bcbstx.com.  Thank you    Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784  Hello Connie,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated.  Thank you.', NULL, NULL, '2021-03-18 12:58:16', '2021-03-18 12:58:16'),
(10735, 3046, 18690, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status. ', NULL, NULL, '2021-03-18 15:53:30', '2021-03-18 15:53:30'),
(10736, 3046, 18690, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: Connie_Traylor@bcbstx.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || : Case Number - 02306784 Dear Connie,  Kindly accept my apologies, kindly note that this is the case number 02278580 for which I wanted to inquire about the status.', NULL, NULL, '2021-03-18 15:54:05', '2021-03-18 15:54:05'),
(10737, 1006, 18690, NULL, '2021-04-28 00:00:00.000', 'Approved', 'Approval received from Sue Chang Sue_Chang@bcbstx.com & BCBS Texas txintaketeampiermailbox@bcbstx.com:  Sub: BCBSTX New Provider Information  \"Group Name : STATCARE MINOR EMERGENCY CLINIC  Group Record Id :  Provider Name : ROSE M PUENTES Provider Record Number : Specialty :  Networks : BAV, BCA, CHP, HME, HMO, PMC, SPL, STK, STR\"  Eff: 04/22/2021  Location confirmation and welcome letters are attached for reference.', NULL, NULL, '2021-04-21 15:44:15', '2021-04-21 15:44:15'),
(10738, 3046, 18691, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:47:13', '2021-03-09 14:47:13'),
(10739, 3046, 18691, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'UHC enrollment has been initiated online for Rose P Trevino.', NULL, NULL, '2021-03-09 14:50:11', '2021-03-09 14:50:11'),
(10740, 3046, 18691, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || UHC ||  Hello, I would like to check the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794   Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415   Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 13:10:47', '2021-03-18 13:10:47'),
(10741, 1006, 18691, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Received the following update from UHC National Credentialing Notifications natlcred_notifications@uhc.com:  Sub: Status on Your Request to Join Our Network and Next Steps  \"ROSE PUENTES-TREVINO rhc@claimsmedinc.com  Re: Status on Your Request to Join Our Network and Next Steps  Dear ROSE PUENTES-TREVINO:  Thank you for your interest in joining the UnitedHealthcare network. Here\'s an update on your request:  Activity	Status Step 1 – Credentialing Review	Completed on 3/23/2021. We’ve verified that you meet UnitedHealthcare’s basic credentialing requirements. Step 2 – Contract Loaded	Pending. We’ll be in touch if we need any additional information to complete your contract or add you to an existing contract. Step 3 – Ready to See Patients	Pending. We’ll notify you of the date you can begin seeing patients as a network provider. Questions? To learn more about our credentialing requirements and contracting process, please visit UHCprovider.com/join. If you have questions, please email us at Networkhelp@uhc.com. . Include the health care professional\'s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request.\"', NULL, NULL, '2021-04-09 11:40:31', '2021-04-09 11:40:31'),
(10742, 1006, 18691, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent a f/u email @ NMRT networkhelp@uhc.com : Sub: Enrollment Status - Rose Trevino - RHC \"Hello,  I wanted to get an update regarding the credentialing/contracting status for the following providers: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 Provider Name: Rose TrevinoNPI# 1437174794 Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-05-11 10:45:32', '2021-05-11 10:45:32'),
(10743, 1006, 18691, NULL, '2021-05-19 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval and location confirmation are attached for reference.   Eff: 03/11/2021', NULL, NULL, '2021-05-12 14:14:23', '2021-05-12 14:14:23'),
(10744, 3046, 18692, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:52:08', '2021-03-09 14:52:08'),
(10745, 3046, 18692, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'UHC enrollment has been initiated online for Rose P Trevino. ', NULL, NULL, '2021-03-09 14:52:18', '2021-03-09 14:52:18');
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
(10746, 3046, 18692, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || UHC ||  Hello, I would like to check the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794   Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415   Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 13:10:23', '2021-03-18 13:10:23'),
(10747, 1006, 18692, NULL, '2021-05-19 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval and location confirmation are attached for reference.   Eff: 03/11/2021', NULL, NULL, '2021-05-12 14:14:28', '2021-05-12 14:14:28'),
(10748, 3046, 18693, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:52:46', '2021-03-09 14:52:46'),
(10749, 3046, 18693, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'UHC enrollment has been initiated online for Rose P Trevino. ', NULL, NULL, '2021-03-09 14:52:56', '2021-03-09 14:52:56'),
(10750, 3046, 18693, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || UHC ||  Hello, I would like to check the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794   Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415   Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 13:10:13', '2021-03-18 13:10:13'),
(10751, 1006, 18693, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent a f/u email @ NMRT networkhelp@uhc.com : Sub: Enrollment Status - Rose Trevino - RHC \"Hello,  I wanted to get an update regarding the credentialing/contracting status for the following providers: Group Name: Statcare Minor Emergency Clinic NPI# 1689924904 Provider Name: Rose TrevinoNPI# 1437174794 Please get back to me as soon as possible. Thank you.\"', NULL, NULL, '2021-05-11 10:46:18', '2021-05-11 10:46:18'),
(10752, 1006, 18693, NULL, '2021-05-19 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval and location confirmation are attached for reference.   Eff: 03/11/2021', NULL, NULL, '2021-05-12 14:14:18', '2021-05-12 14:14:18'),
(10753, 3046, 18694, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 14:53:25', '2021-03-09 14:53:25'),
(10754, 3046, 18694, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'UHC enrollment has been initiated online for Rose P Trevino. ', NULL, NULL, '2021-03-09 14:53:33', '2021-03-09 14:53:33'),
(10755, 3046, 18694, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: networkhelp@uhc.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || UHC ||  Hello, I would like to check the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794   Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363   Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410   Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413   Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415   Your quick response in this regard will be highly appreciated.  Thank you', NULL, NULL, '2021-03-18 13:11:01', '2021-03-18 13:11:01'),
(10756, 1006, 18694, NULL, '2021-05-19 00:00:00.000', 'Approved', 'The provider is enrolled with UHC, approval and location confirmation are attached for reference.   Eff: 03/11/2021', NULL, NULL, '2021-05-12 14:14:26', '2021-05-12 14:14:26'),
(10757, 3046, 18695, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 15:33:08', '2021-03-09 15:33:08'),
(10758, 3046, 18695, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Cigna has been initiated over the phone. Application # is 12518362 and the Provider # is 0716400. It will take approximately 90 - 120 days. Already requested (REP) Natale  if she could requested it on priority basis.', NULL, NULL, '2021-03-09 15:35:32', '2021-03-09 15:35:32'),
(10759, 3046, 18695, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Cigna || Greetings,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated. Thank you.', NULL, NULL, '2021-03-18 10:47:17', '2021-03-18 10:47:17'),
(10760, 1006, 18695, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Received the following update from Cigna @ Cigna Provider Onboarding Status 9psscent@cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"Re:	Reference number 12518362 Application complete: Credentialing process to begin Dear ROSE TREVINO,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-04-21 13:31:40', '2021-04-21 13:31:40'),
(10761, 9057, 18695, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to PDMCOGZ@cigna.com Sub: Request for Enrollment Status || Reference number 12518362 || Trevino, Rose Puentes || RHC || Cigna ||  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  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  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 08:53:17', '2021-05-26 08:53:17'),
(10762, 1006, 18695, NULL, '2021-06-18 00:00:00.000', 'In Process', 'WE cannot access Saim\'s email so I sent another f/u email @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment Status - RHC - Cigna (Ref# 12518362 )  \"Hello, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 14:25:17', '2021-06-11 14:25:17'),
(10763, 3040, 18695, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I spoke to Lynn B and she said the provider is in-network with Cigna but its not showing on the provider directory.   Ref: Lynn B 06/30/2021', NULL, NULL, '2021-06-30 15:33:33', '2021-06-30 15:33:33'),
(10764, 1006, 18695, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email from Welcome Health Care Provider discovercigna@information.cigna.com:  Sub: Welcome to the Cigna network  \"Dear ROSE TREVINO,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 05/06/2021. Your provider identification number is‍ ‌0716400. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).\"  Location confirmation is attached for reference.', NULL, NULL, '2021-07-12 14:12:03', '2021-07-12 14:12:03'),
(10765, 3046, 18696, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 15:35:49', '2021-03-09 15:35:49'),
(10766, 3046, 18696, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Cigna has been initiated over the phone. Application # is 12518362 and the Provider # is 0716400. It will take approximately 90 - 120 days. Already requested (REP) Natale  if she could requested it on priority basis.', NULL, NULL, '2021-03-09 15:36:02', '2021-03-09 15:36:02'),
(10767, 3046, 18696, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Cigna || Greetings,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated. Thank you.', NULL, NULL, '2021-03-18 10:47:15', '2021-03-18 10:47:15'),
(10768, 1006, 18696, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Received the following update from Cigna @ Cigna Provider Onboarding Status 9psscent@cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"Re:	Reference number 12518362 Application complete: Credentialing process to begin Dear ROSE TREVINO,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-04-21 13:31:35', '2021-04-21 13:31:35'),
(10769, 1006, 18696, NULL, '2021-05-04 00:00:00.000', 'In Process', 'As per my discussion with Cigna 4th address has been added to the group, but not to any of the providers. Ref# Cherrelle 04/27/2021  I submitted another LOI/W9 with all provider\'s information to pdm_intake@cigna.com, attached in the group task.  ', NULL, NULL, '2021-04-27 16:00:34', '2021-04-27 16:00:34'),
(10770, 9057, 18696, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to intake_pdm@cigna.com Sub: Enrollment request status -RHC-Cigna  Hello, We submitted a request to add a quaternary location under our practice and providers. Kindly provide the current status for the above mentioned request.    Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able.  Thanks.', NULL, NULL, '2021-05-25 17:01:05', '2021-05-25 17:01:05'),
(10771, 1006, 18696, NULL, '2021-06-18 00:00:00.000', 'In Process', 'WE cannot access Saim\'s email so I sent another f/u email @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment Status - RHC - Cigna (Ref# 12518362 )  \"Hello, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 14:25:10', '2021-06-11 14:25:10'),
(10772, 3040, 18696, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I spoke to Lynn B and she said the provider is in-network with Cigna but its not showing on the provider directory.   Ref: Lynn B 06/30/2021', NULL, NULL, '2021-06-30 15:33:28', '2021-06-30 15:33:28'),
(10773, 1006, 18696, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email from Welcome Health Care Provider discovercigna@information.cigna.com:  Sub: Welcome to the Cigna network  \"Dear ROSE TREVINO,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 05/06/2021. Your provider identification number is‍ ‌0716400. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).\"  Location confirmation is attached for reference.', NULL, NULL, '2021-07-12 14:11:58', '2021-07-12 14:11:58'),
(10774, 3046, 18697, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 15:36:21', '2021-03-09 15:36:21'),
(10775, 3046, 18697, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Cigna has been initiated over the phone. Application # is 12518362 and the Provider # is 0716400. It will take approximately 90 - 120 days. Already requested (REP) Natale  if she could requested it on priority basis.', NULL, NULL, '2021-03-09 15:36:32', '2021-03-09 15:36:32'),
(10776, 3046, 18697, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Cigna || Greetings,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated. Thank you.', NULL, NULL, '2021-03-18 10:47:12', '2021-03-18 10:47:12'),
(10777, 1006, 18697, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Received the following update from Cigna @ Cigna Provider Onboarding Status 9psscent@cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"Re:	Reference number 12518362 Application complete: Credentialing process to begin Dear ROSE TREVINO,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-04-21 13:31:29', '2021-04-21 13:31:29'),
(10778, 9057, 18697, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to PDMCOGZ@cigna.com Sub: Request for Enrollment Status || Reference number 12518362 || Trevino, Rose Puentes || RHC || Cigna ||  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  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  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 08:53:25', '2021-05-26 08:53:25'),
(10779, 1006, 18697, NULL, '2021-06-18 00:00:00.000', 'In Process', 'WE cannot access Saim\'s email so I sent another f/u email @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment Status - RHC - Cigna (Ref# 12518362 )  \"Hello, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 14:25:06', '2021-06-11 14:25:06'),
(10780, 1006, 18697, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I spoke to Lynn B and she said the provider is in-network with Cigna but its not showing on the provider directory.   Ref: Lynn B 06/30/2021', NULL, NULL, '2021-06-30 17:04:10', '2021-06-30 17:04:10'),
(10781, 1006, 18697, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email from Welcome Health Care Provider discovercigna@information.cigna.com:  Sub: Welcome to the Cigna network  \"Dear ROSE TREVINO,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 05/06/2021. Your provider identification number is‍ ‌0716400. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).\"  Location confirmation is attached for reference.', NULL, NULL, '2021-07-12 14:11:53', '2021-07-12 14:11:53'),
(10782, 3046, 18698, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 15:36:53', '2021-03-09 15:36:53'),
(10783, 3046, 18698, NULL, '2021-03-16 00:00:00.000', 'Initiated', 'Cigna has been initiated over the phone. Application # is 12518362 and the Provider # is 0716400. It will take approximately 90 - 120 days. Already requested (REP) Natale  if she could requested it on priority basis.', NULL, NULL, '2021-03-09 15:37:04', '2021-03-09 15:37:04'),
(10784, 3046, 18698, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: ONBEloquaNotice@cigna.com Subject: Request for Enrollment Status || Trevino, Rose Puentes || RHC || Cigna || Greetings,  Hope you are doing well. I would like to request you for the enrollment status for below mentioned provider:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Practice Details 1: Practice Name:  Statcare Minor Emergency Clinic (Kingsville) Practice Tax-ID:  46-0575924 Practice NPI:      1689924904   Practice Address: 500 E CAESAR KINGSVILLE , TX 78363  Practice Details 2: Practice Name:  Statcare Minor Emergency Clinic (Calallen) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 4042 River Hill Corpus Christi , TX 78410  Practice Details 3: Practice Name:  Statcare Minor Emergency Clinic (Staples) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 6646 S. Staples St. # 122 Corpus Christi , TX 78413  Practice Details 4: Practice Name:  Statcare Minor Emergency Clinic (SPID) Practice Tax-ID: 46-0575924 Practice NPI:     1689924904 Practice Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Your quick response in this regard will be highly appreciated. Thank you.', NULL, NULL, '2021-03-18 10:47:14', '2021-03-18 10:47:14'),
(10785, 1006, 18698, NULL, '2021-04-28 00:00:00.000', 'In Process', 'Received the following update from Cigna @ Cigna Provider Onboarding Status 9psscent@cigna.com:  Sub: Cigna Credentialing Status Update: Credentialing Verification  \"Re:	Reference number 12518362 Application complete: Credentialing process to begin Dear ROSE TREVINO,  We have confirmed that your application is complete, and have forwarded it for credentialing review  What happens next?  During this stage of the application process, Credentialing will perform primary source verification, and your application will be reviewed by the Credentialing committee. We will contact you if we need any additional information, and will let you know when this step is complete.  Sincerely, Cigna\"', NULL, NULL, '2021-04-21 13:31:21', '2021-04-21 13:31:21'),
(10786, 9057, 18698, NULL, '2021-06-02 00:00:00.000', 'In Process', 'We sent an email to PDMCOGZ@cigna.com Sub: Request for Enrollment Status || Reference number 12518362 || Trevino, Rose Puentes || RHC || Cigna ||  Hello, We submitted a request for the enrollment of below mentioned provider under the following group:  Provider Details: Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  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  Kindly let us know what is the current status regarding our request as soon as possible.  Thank you ', NULL, NULL, '2021-05-26 08:53:09', '2021-05-26 08:53:09'),
(10787, 1006, 18698, NULL, '2021-06-18 00:00:00.000', 'In Process', 'WE cannot access Saim\'s email so I sent another f/u email @ PDM COGZ PDMCOGZ@cigna.com:  Sub: Enrollment Status - RHC - Cigna (Ref# 12518362 )  \"Hello, I hope you\'re doing well, I wanted to get an update regarding the enrollment status for the following provider under our group:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Provider Name: Trevino, Rose Puentes Provider NPI: 1437174794  Please get back to me as soon as possible. Thank you. \"', NULL, NULL, '2021-06-11 14:24:55', '2021-06-11 14:24:55'),
(10788, 3040, 18698, NULL, '2021-07-07 00:00:00.000', 'In Process', 'I spoke to Lynn B and she said the provider is in-network with Cigna but its not showing on the provider directory.   Ref: Lynn B 06/30/2021', NULL, NULL, '2021-06-30 15:33:23', '2021-06-30 15:33:23'),
(10789, 1006, 18698, NULL, '2021-07-19 00:00:00.000', 'Approved', 'Email from Welcome Health Care Provider discovercigna@information.cigna.com:  Sub: Welcome to the Cigna network  \"Dear ROSE TREVINO,  Congratulations! Your application to participate in the Cigna network has been approved. Our shared focus is on the health and well-being of every person we serve. Working together, we can help them live healthy life.  Jeff Panter  Vice President  Provider Relations & Solutions Management  Jeff Panter	 Let’s get started Your effective date is 05/06/2021. Your provider identification number is‍ ‌0716400. Please take a moment to register for the Cigna for Health Care Professionals website (CignaforHCP.com).\"  Location confirmation is attached for reference.', NULL, NULL, '2021-07-12 14:11:47', '2021-07-12 14:11:47'),
(10790, 3040, 18699, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-09 15:47:20', '2021-03-09 15:47:20'),
(10791, 3040, 18699, NULL, '2021-03-16 00:00:00.000', 'Approved', 'Location added ', NULL, NULL, '2021-03-09 15:54:50', '2021-03-09 15:54:50'),
(10792, 1006, 18700, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-10 10:44:01', '2021-03-10 10:44:01'),
(10793, 1006, 18700, NULL, '2021-03-17 00:00:00.000', 'Initiated', 'The request has been submitted via POSC:  Here is your Application Tracking Number (ATN): 204535', NULL, NULL, '2021-03-10 10:44:53', '2021-03-10 10:44:53'),
(10794, 1006, 18700, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following reply from MassHealth @ Knott, Philip PhilipKnott@maximus.com: \"Good morning,  This is Philip Knott from MassHealth Provider Enrollment and Credentialing. We received your application via our Provider Online Service Center (POSC) on 3/10/2021.  There is some missing information in your application which needs to be addressed before credentialing can be completed:  Provider’s home address Medicaid information (Medicaid number and effective dates) for any other states where the provider has participated in Medicaid, if applicable. Additionally, applications submitted via POSC still require the submission of 3 paper forms (attached). Please note that signatures must be physical.  Federally Required Disclosures Form Provider Contract for Individuals Section 4 – Disclosures of the Provider Application   Please don’t hesitate to contact me with any questions you may have! As soon as we have this information we can immediately finish credentialing the application.  Also please let me know if you are only completing a MassHealth application solely for licensure reasons or have recently received your license and are not billing MassHealth, as you may need a different enrollment.  Best,  Philip        Philip Knott Provider Enrollment Coordinator  MassHealth 55 Summer Street, 8th Floor Boston, MA 02110\"  Forms were filled out and sent back to Philip.  ', NULL, NULL, '2021-03-22 11:34:57', '2021-03-22 11:34:57'),
(10795, 1006, 18700, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Received the following reply from Knott, Philip PhilipKnott@maximus.com:  \"Good afternoon,  Thank you for sending those forms over!  The only other thing I need is Medicaid information. Has the provider ever participated in Medicaid in any other states? If so, I need the Medicaid numbers and effective dates for every state where they have participated.\"  Asked Carlee if she can provide us this information so we can proceed, sent her an email via BlueHost. ', NULL, NULL, '2021-03-23 16:19:40', '2021-03-23 16:19:40'),
(10796, 1006, 18700, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Submitted following email to \"Knott, Philip\" PhilipKnott@maximus.com:  \"Good morning Philip,   I apologize for the wait, here are the forms with the signatures from both providers. Please let me know if anything else is required and what the expected time-frame is for the completion of this request?  Thank you. \"', NULL, NULL, '2021-03-29 08:25:45', '2021-03-29 08:25:45'),
(10797, 1019, 18700, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Sent the following email to : PhilipKnott@maximus.com   Hello Phillip, Is there any other stuff you need from us for Carlee Rozell and Lynnetta Loveland, also if everything has been delivered to you regarding these providers, also let me know the time frame to complete these enrollments. I will appreciate it if you will get back to me ASAP.', NULL, NULL, '2021-04-02 09:10:15', '2021-04-02 09:10:15'),
(10798, 1019, 18700, NULL, '2021-04-14 00:00:00.000', 'New/Not Initiated', 'Sent the following email to Maribel Hello Maribel,   I appreciate the update on all of the providers, can we get their requests expedited?  Thank you very much.  ', NULL, NULL, '2021-04-07 10:01:50', '2021-04-07 10:01:50'),
(10799, 1019, 18700, NULL, '2021-04-14 00:00:00.000', 'In Process', 'Received the following email from Maribel.  Good Morning This provider ID# 110171088A ROZELL , CARLEE A- Fully enrolled and linked to: The rest are in progress.    See Attachment for reference ', NULL, NULL, '2021-04-07 10:02:58', '2021-04-07 10:02:58'),
(10800, 1019, 18700, NULL, '2021-04-14 00:00:00.000', 'Approved', 'Received Welcome Letter effective date 04/02/2021 see attachments for reference', NULL, NULL, '2021-04-07 13:08:09', '2021-04-07 13:08:09'),
(10801, 3046, 18702, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-10 15:12:14', '2021-03-10 15:12:14'),
(10802, 3046, 18702, NULL, '2021-03-17 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com CC to: Mescobar2@humana.com Subject: Demographic Change_2000173852338Hello,  Kindly find the attached roster to add two locations for below mentioned practice:  Practice Details 1: Practice Name: Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Practice Details 2: Practice Name:Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 4042 River Hill Corpus Christi , TX 78410  Thank you.', NULL, NULL, '2021-03-10 15:13:58', '2021-03-10 15:13:58'),
(10803, 3046, 18702, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com Subject: Demographic Change_2000173852338  Hello,  Hope my email finds you well. I would like to get the updated status for my request for adding two locations for below mentioned practice: Practice Details 1:Practice Name: Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Practice Details 2:Practice Name: Statcare Minor Emergency ClinicPractice ID: 46-0575924Practice NPI: 1689924904Address: 4042 River Hill Corpus Christi , TX 78410  Thank you.', NULL, NULL, '2021-03-18 13:16:49', '2021-03-18 13:16:49'),
(10804, 1006, 18702, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent following email @ Katherine Moten KMoten4@humana.com:   Sub: Provider Enrollment & Additional Information Request - RHC - Tricare  \"Hello Katherine,  I hope you\'re doing well, I have a few queries and requests for enrollment of our providers, are all of the following providers coming up as certified? If so please let me know what is needed to get them credentialed under our group and for the providers that are already credentialed and in-network, please let me know what their effective date is and add all of the mentioned addresses under them and also update them on the Humana Military Provider directory. The provider information is as follows:     Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me regarding these providers as soon as possible.  Thank you.\"', NULL, NULL, '2021-04-08 18:04:35', '2021-04-08 18:04:35'),
(10805, 9057, 18702, NULL, '2021-06-02 00:00:00.000', 'In Process', 'Sent following email to KMoten4@humana.com Sub: Enrollment request status -RHC- Tricare Hello, We submitted a request for the enrollment for the following providers under the mentioned practice,and asked some queries in the last email. Kindly reply as soon as possible.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Rabagos, Katherine Provider NPI# 1134415631 Provider 8: Provider Name: Francis, William Robert Provider NPI# 1457994436 Provider 9: Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597 Provider 10: Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Thank You', NULL, NULL, '2021-05-25 16:24:30', '2021-05-25 16:24:30'),
(10806, 1006, 18702, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Received the following reply from Katherine @ Katherine Moten KMoten4@humana.com:   Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Sent following reply to add providers to group via portal @ Katherine: \"Hello Katherine,   Appreciate the reply, can you please also answer this query:   \"Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?\"  Thank you!\"', NULL, NULL, '2021-06-11 16:44:34', '2021-06-11 16:44:34'),
(10807, 1006, 18702, NULL, '2021-07-08 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you! ', NULL, NULL, '2021-07-01 13:19:39', '2021-07-01 13:19:39'),
(10808, 1006, 18702, NULL, '2021-08-16 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The roster has been sent and is attached to the main group tasks.  ', NULL, NULL, '2021-08-09 16:55:24', '2021-08-09 16:55:24'),
(10809, 1006, 18702, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:50:34', '2021-08-24 14:50:34'),
(10810, 11056, 18702, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:09', '2021-09-21 16:08:09'),
(10811, 11056, 18702, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:51:54', '2021-10-01 12:51:54'),
(10812, 11056, 18702, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:50:45', '2021-10-18 15:50:45'),
(10813, 11056, 18702, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:56:05', '2021-10-26 11:56:05'),
(10814, 11056, 18702, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:57', '2021-11-11 14:39:57'),
(10815, 11056, 18702, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:03:20', '2021-12-02 16:03:20'),
(10816, 11056, 18702, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:10:31', '2021-12-16 14:10:31'),
(10817, 11056, 18702, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Group     Effective dates   CALALLEN  -  6/1/2017 STAPLES   -  6/1/2017 SPID     -  6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:25:49', '2021-12-21 13:25:49'),
(10818, 3046, 18703, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-10 15:14:45', '2021-03-10 15:14:45'),
(10819, 3046, 18703, NULL, '2021-03-17 00:00:00.000', 'Initiated', 'Email sent to: stxnm@humana.com CC to: Mescobar2@humana.com Subject: Demographic Change_2000173852338Hello,  Kindly find the attached roster to add two locations for below mentioned practice:  Practice Details 1: Practice Name: Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Practice Details 2: Practice Name:Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 4042 River Hill Corpus Christi , TX 78410  Thank you.', NULL, NULL, '2021-03-10 15:15:14', '2021-03-10 15:15:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10820, 3046, 18703, NULL, '2021-03-25 00:00:00.000', 'In Process', 'Email sent to: stxnm@humana.com Subject: Demographic Change_2000173852338  Hello,  Hope my email finds you well. I would like to get the updated status for my request for adding two locations for below mentioned practice: Practice Details 1:Practice Name: Statcare Minor Emergency Clinic Practice ID: 46-0575924 Practice NPI: 1689924904 Address: 3817 South Padre Island Drive Corpus Christi , TX 78415  Practice Details 2:Practice Name: Statcare Minor Emergency ClinicPractice ID: 46-0575924Practice NPI: 1689924904Address: 4042 River Hill Corpus Christi , TX 78410  Thank you.', NULL, NULL, '2021-03-18 13:16:32', '2021-03-18 13:16:32'),
(10821, 3040, 18703, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Adding Location || Statcare Minor Emergency Clinic || Group || Tricare ||  Greetings,  Hope you are doing well. I wanted to add the providers in the Tricare for our group Statcare Minor Emergency Clinic under the below locations.  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE , TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi , TX 78413 Tertiary Location: 4042 River Hill Corpus Christi , TX 78410 Additional Location: 3817 South Padre Island Drive Corpus Christi , TX 78415  If you need any additional information please let me know. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-04-08 17:03:47', '2021-04-08 17:03:47'),
(10822, 1006, 18703, NULL, '2021-06-11 00:00:00.000', 'In Process', 'Sent f/u email @ Katherine Moten KMoten4@humana.com:  Sub: Re: Secured: RE: Enrollment request status -RHC- Tricare  \"Hello Katherine,   The quaternary location is still not showing up on the Tricare portal, please add it to our group so we can add it to our providers as well:  Group Name: Statcare Minor Emergency Clinic (SPID) NPI# 1689924904 TIN# 46-0575924 Address: 3817 South Padre Island Drive, Corpus Christi, TX 78415  Also, please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Thank you. \"', NULL, NULL, '2021-06-04 13:51:44', '2021-06-04 13:51:44'),
(10823, 1006, 18703, NULL, '2021-06-18 00:00:00.000', 'In Process', 'We received the following update from Katherine @ Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Secured: RE: Enrollment request status -RHC- Tricare  \"Good Morning,  When a new location needs to be added to your group, you will need to complete the attached form and fax to the number on the form.  Respectfully, Katherine Moten TRICARE Community Liaison II Humana  T 502-318-5250  F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  The form has been filled out and faxed @ (608) 221-7535. Attached for reference in the main group task.  ', NULL, NULL, '2021-06-11 16:54:46', '2021-06-11 16:54:46'),
(10824, 3040, 18703, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Sub: RE: Enrollment request status -RHC- Tricare  Hello Katherine,  Hope you are doing well. Please do let me know what the procedure is to add providers to the affiliated locations via the provider portal as some of them are not added yet?  Practice Details: Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904 Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Providers Provider 1: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239 Provider 2: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945 Provider 3: Provider Name: Mason, Traci Smith Provider NPI# 1497127831 Provider 4: Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794 Provider 5: Provider Name: Svatek, Maegan Provider NPI# 1639670250 Provider 6: Provider Name: Rogers, Petina L. Provider NPI# 1801443916 Provider 7: Provider Name: Capupus, Juan Provider NPI# 1891168597  Please respond to me soon. If you need any documents feel free to contact me.  Thank you!', NULL, NULL, '2021-06-30 17:00:33', '2021-06-30 17:00:33'),
(10825, 1006, 18703, NULL, '2021-08-19 00:00:00.000', 'In Process', 'We received the following update from Katherine Moten KMoten4@humana.com:  Sub: Secured: RE: Enrollment request status -RHC- Tricare  \"Please complete the attached spreadsheet and email to our roster upload team: HGBProviderRosters@humana.com  Respectfully, Katherine Moten TRICARE Community Liaison II Humana T 502-318-5250 F 210-239-0401 kmoten4@humana.com HumanaMilitary.com\"  Roster has been sent and is attached in main group tasks.  ', NULL, NULL, '2021-08-12 16:31:45', '2021-08-12 16:31:45'),
(10826, 1006, 18703, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Sent f/u email @ HGBProviderRosters@humana.com & KMoten4@humana.com:  Sub: Provider Information Update  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group and providers had their addresses updated as of yet or not:   Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-24 14:48:34', '2021-08-24 14:48:34'),
(10827, 11056, 18703, NULL, '2021-09-28 00:00:00.000', 'In Process', 'Email sent to : JTRENZ@humana.com  Sub  : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. I wanted to verify if the following group and providers had their addresses updated as of yet or not. And please update me regarding their certification and credentialing process too.  Practice Details:  Practice Name: Statcare Minor Emergency Clinic Practice Tax ID# 46-0575924 Practice NPI# 1689924904  Primary Location: 500 E CAESAR  KINGSVILLE, TX 78363 Secondary Location: 6646 S. Staples St. # 122 Corpus Christi, TX 78413 Tertiary Location: 4042 River Hill Corpus Christi, TX 78410 Quaternary Location: 3817 South Padre Island Drive Corpus Christi, TX 78415  Provider Details: Provider Name: Ayarzagoitia, Patrick A. Provider NPI# 1649568239  Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Francis, William Robert Provider NPI# 1457994436  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597  Provider Name: Gonzalez, Mary C Provider NPI# 1952713083  If you need any documents or information please don\'t hesitate in contacting me back soon. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-21 16:08:15', '2021-09-21 16:08:15'),
(10828, 11056, 18703, NULL, '2021-10-08 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon.       Our directory shows the addresses for the four locations mentioned are current.     Please see below for individual provider information:     NPI 1649568239  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1740517945  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1497127831  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1437174794  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1639670250  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1801443916  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1134415631  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1457994436  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.     NPI 1891168597  Provider is certified and affiliated to all 4 locations.  Credentialing application required.     NPI 1952713083  Provider is certified and affiliated to all 4 locations.  Credentialing is complete & provider is network.   The following is required in order to complete credentialing for above mentioned providers who are not currently network.    Also attached is a Provider Roster for future use when updating provider information.    Thank you, Jacque Trenz Health System Consultant Humana Military TRICARE East', NULL, NULL, '2021-10-01 12:56:20', '2021-10-01 12:56:20'),
(10829, 11056, 18703, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good morning!  Hope this email finds you well. Please provide the credentialing application so I will fill that out for you & attach all the required documents with that. Please also assist with the below at your earliest opportunity.  Provider Name: Gonzalez, Mary C : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1952713083  Provider Name: Francis, William Robert : Please provide us the effective dates & welcome letter for the provider soon. Provider NPI# 1457994436  I didn\'t find any roster attached to your email. Please get back to me at your earliest convenience.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-18 15:50:50', '2021-10-18 15:50:50'),
(10830, 11056, 18703, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email sent to: jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   Good afternoon!  Hope all is well with you. There are so many forms, I am a little bit confused in selecting between the forms.  Could you just do me a favour and provide me with the TSCA cred application at your earliest convenience?  Eagerly, waiting for your response.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-26 11:56:11', '2021-10-26 11:56:11'),
(10831, 11056, 18703, NULL, '2021-11-18 00:00:00.000', 'In Process', 'Email received from : jtrenz@humana.com  Sub : Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare   A copy is attached.  However, on the website it is easier to type it in instead of handwriting it.  .     Click the link. Then click on the Credentialing Application forms page.  Then click on the LHL234 – PDF version.  The PDF version lets you type out the information using your computer.', NULL, NULL, '2021-11-11 14:39:51', '2021-11-11 14:39:51'),
(10832, 11056, 18703, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope you are having a productive day. Please find the attached applications for the credentialing process of the below-mentioned providers as per your request.  Provider Details: Provider Name: Capupus, Mari Katrina Provider NPI# 1740517945  Provider Name: Mason, Traci Smith Provider NPI# 1497127831  Provider Name: Trevino, Rose Puentes. Provider NPI# 1437174794  Provider Name: Svatek, Maegan Provider NPI# 1639670250  Provider Name: Rogers, Petina L. Provider NPI# 1801443916  Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider Name: Capupus, Juan Miguel Provider NPI# 1891168597   If you require anything else please let me know. Take Care  Thank you! Have a great day', NULL, NULL, '2021-12-02 16:03:27', '2021-12-02 16:03:27'),
(10833, 11056, 18703, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to:  JTRENZ@humana.com  Sub:  Enrollment Status Query - Statcare Minor Emergency Clinic - Tricare  Good afternoon!  Hope this email finds you well. Any updates on the certification and credentialing of the remaining providers?  Please get back to me as soon as possible.  Thank you! Have a nice day!', NULL, NULL, '2021-12-16 14:10:23', '2021-12-16 14:10:23'),
(10834, 11056, 18703, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Group     Effective dates   CALALLEN  - 1/6/2017 STAPLES  -  1/6/2017 SPID     -  1/6/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:23:04', '2021-12-21 13:23:04'),
(10835, 11056, 18703, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Rep: Otis J  Group     Effective dates   CALALLEN  -  6/1/2017 STAPLES   -  6/1/2017 SPID     -  6/1/2017  Refcode: 14725307  Please see the attachments', NULL, NULL, '2021-12-21 13:24:39', '2021-12-21 13:24:39'),
(10836, 3040, 18704, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-10 17:09:13', '2021-03-10 17:09:13'),
(10837, 3040, 18704, NULL, '2021-03-17 00:00:00.000', 'In Process', 'Application is still processing at this time. ', NULL, NULL, '2021-03-10 17:10:01', '2021-03-10 17:10:01'),
(10838, 3040, 18704, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Email sent to: martha.butler@dchstx.org, Miguel.Zamora@dchstx.org, Diana.Flores@dchstx.org, Christine.Rodriguez@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Greetings,   Hope you are doing well. I wanted to add the provider in the Driscoll Health plan for our group Valley Med Urgent Care PLLC under below locations.  Provider 1:   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-23 15:45:06', '2021-03-23 15:45:06'),
(10839, 3040, 18704, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email sent to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good Morning Diana,   Can you please send me the provider representative contact information for adding the locations.   Thank you ', NULL, NULL, '2021-03-29 09:38:15', '2021-03-29 09:38:15'),
(10840, 3040, 18704, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good morning Adi,  I looked up Dr. Saavedra’s account only has primary location listed to add additional locations, Please Contact your provider representative to add the additional locations  Thank you  Sincerely  Diana R. Flores Credentialing Specialist', NULL, NULL, '2021-03-29 09:39:06', '2021-03-29 09:39:06'),
(10841, 3040, 18704, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd to: Diana.Flores@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Good morning Adi,  Please contact your provider representative  Thank you     Sincerely     Diana R. Flores  Credentialing Specialist', NULL, NULL, '2021-03-29 09:39:35', '2021-03-29 09:39:35'),
(10842, 3040, 18704, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Email rcvd from: Christine.Rodriguez@dchstx.org  Subject: Location Addition || Valley Med Urgent Care PLLC || Saavedra, Teresa || Driscoll||  Hello,  I will forward this information to our Provider Relations Department; they  will reach out to you for further assistance.   Have a Great Day.   Thank you, Christine S Rodriguez', NULL, NULL, '2021-03-29 09:40:48', '2021-03-29 09:40:48'),
(10843, 3040, 18704, NULL, '2021-04-20 00:00:00.000', 'In Process', 'Email sent to: DHPContracting@dchstx.org,  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Greetings,   Hope you are doing well. Please find the attached letter of intent to add the providers in additional locations for our group Valley Med Urgent Care PLLC.   Provider 1: Provider Name: Escobar, Angiollet Solis Individual NPI# 1962917997 Individual TPI#: 395917301 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 3: Provider Name: Hernandez, Eder Francisco Individual NPI# 1386956852 Individual TPI#:371793603 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 4: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Thank you  ', NULL, NULL, '2021-04-13 13:35:58', '2021-04-13 13:35:58'),
(10844, 3040, 18704, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,  Thank you so much for your prompt response. Can you please advise me the time frame?   Waiting to hear from you soon.   Thanks  ', NULL, NULL, '2021-04-15 15:40:20', '2021-04-15 15:40:20'),
(10845, 3040, 18704, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello again Adil,  Wanted to let you know that only 2 of these providers needed the locations added  Cynthia Rodriguez PA andTeresa Saavedra DO', NULL, NULL, '2021-04-15 15:42:08', '2021-04-15 15:42:08'),
(10846, 3040, 18704, NULL, '2021-05-11 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   I checked the below providers on the Driscoll Health Plan provider directory and the providers are not showing in below locations which I requested in my previous email. Can you please check and let me know when they will be updated in the directory.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice NPI# 1518404631 Practice Tax ID#  81-5123542 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Address:  800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Provider 1: Provider Name: Rodriguez, Cynthia Individual NPI# 1124282553 Individual TPI#:198813103 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Provider 2: Provider Name: Saavedra, Teresa Individual NPI# 1255676151 Individual TPI#:351186703 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite#170 McAllen , TX 78501-1166  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-04 13:16:00', '2021-05-04 13:16:00'),
(10847, 3040, 18704, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  Hello Karla,   Has there been any update regarding the additional locations.   Thanks  ', NULL, NULL, '2021-05-28 08:59:38', '2021-05-28 08:59:38'),
(10848, 3040, 18704, NULL, '2021-06-10 00:00:00.000', 'Approved', 'Email rcvd from: Karla.Claunch@dchstx.org  Subject:Additional Location || Valley Med Urgent Care PLLC || Providers || Driscoll ||  These were added on the date of the request 4/13/2021', NULL, NULL, '2021-06-03 15:40:54', '2021-06-03 15:40:54'),
(10849, 1006, 19667, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 11:23:59', '2021-03-11 11:23:59'),
(10850, 1006, 19667, NULL, '2021-03-18 00:00:00.000', 'Initiated', 'Submitted online application via POSC: Here is your Application Tracking Number (ATN): 204565', NULL, NULL, '2021-03-11 11:24:20', '2021-03-11 11:24:20'),
(10851, 1006, 19667, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following reply from Masshealth:  \"Good morning,  This is Philip Knott from MassHealth Provider Enrollment and Credentialing. We received your application via our Provider Online Service Center (POSC) on 3/11/2021.  There is some missing information in your application which needs to be addressed before credentialing can be completed:  Provider’s home address Medicaid information (Medicaid number and effective dates) for any other states where the provider has participated in Medicaid, if applicable. Additionally, applications submitted via POSC still require the submission of 3 paper forms (attached). Please note that signatures must be physical.  Federally Required Disclosures Form Provider Contract for Individuals Section 4 – Disclosures of the Provider Application   Please don’t hesitate to contact me with any questions you may have! As soon as we have this information we can immediately finish credentialing the application.  Also please let me know if you are only completing a MassHealth application solely for licensure reasons or have recently received your license and are not billing MassHealth, as you may need a different enrollment.  Best,  Philip        Philip Knott Provider Enrollment Coordinator  MassHealth 55 Summer Street, 8th Floor Boston, MA 02110\"  Information was filled out and sent back to Philip. ', NULL, NULL, '2021-03-22 11:24:03', '2021-03-22 11:24:03'),
(10852, 1006, 19667, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Received the following reply from Knott, Philip PhilipKnott@maximus.com:  \"Good afternoon,  Thank you for sending those forms over!  The only other thing I need is Medicaid information. Has the provider ever participated in Medicaid in any other states? If so, I need the Medicaid numbers and effective dates for every state where they have participated.\"  Asked Nita if she can provide us this information so we can proceed, sent her an email via BlueHost. ', NULL, NULL, '2021-03-23 16:19:16', '2021-03-23 16:19:16'),
(10853, 1006, 19667, NULL, '2021-04-05 00:00:00.000', 'In Process', 'Submitted following email to \"Knott, Philip\" PhilipKnott@maximus.com:  \"Good morning Philip,   I apologize for the wait, here are the forms with the signatures from both providers. Please let me know if anything else is required and what the expected time-frame is for the completion of this request?  Thank you. \"', NULL, NULL, '2021-03-29 08:25:52', '2021-03-29 08:25:52'),
(10854, 1019, 19667, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Sent the following email to : PhilipKnott@maximus.com   Hello Phillip, Is there any other stuff you need from us for Carlee Rozell and Lynnetta Loveland, also if everything has been delivered to you regarding these providers, also let me know the time frame to complete these enrollments. I will appreciate it if you will get back to me ASAP.', NULL, NULL, '2021-04-02 09:11:06', '2021-04-02 09:11:06'),
(10855, 1019, 19667, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from:  PhilipKnott@maximus.com I have everything I need to credential the application for Carlee Rozell and Lynetta Loveland.    Unfortunately I cannot give you a time frame for the completion of their enrollments as that will be determined by the departments who handle the application after I complete credentialing; however, we usually try to complete enrollment within 30 days of the receipt date.', NULL, NULL, '2021-04-05 08:20:06', '2021-04-05 08:20:06'),
(10856, 1019, 19667, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Sent the following email to PhilipKnott@maximus.com  Hello Philip, I can see that Lynetta Loveland has been enrolled and linked to our group  on POSC, can you please send me the copy of the Welcome letter?  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 Tax ID: 834482753  Individual NPI: Lynnetta Loveland NPI: 1598163602  Regards, Alex', NULL, NULL, '2021-04-09 10:34:07', '2021-04-09 10:34:07'),
(10857, 1019, 19667, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to :MaribelPerezLorenzo@maximus.com, KyleRippstein@maximus.com, RobertDWint@maximus.com   Hello, Can you please let us know about the status for the enrollments under our group for the below mentioned providers.  Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753 NPI# 1356906572  Provider Name: Lynnetta Loveland NPI# 1598163602 Provider Name: Barbara Hignite NPI# 1982617262 Provider Name: Rodesia Edmundson NPI# 1124622667  Regards, Alex', NULL, NULL, '2021-04-14 10:34:29', '2021-04-14 10:34:29'),
(10858, 1019, 19667, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Welcome letter received effective date 04/05/2021', NULL, NULL, '2021-04-15 11:17:20', '2021-04-15 11:17:20'),
(10859, 3040, 19668, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 14:34:37', '2021-03-11 14:34:37'),
(10860, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. I just wanted to follow up email regarding the enrollment status of the below mentioned provider.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:40:23', '2021-03-11 14:40:23'),
(10861, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Follow up email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well. This is a follow up email regarding the enrollment status of below mentioned provider.  Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Secondary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166   Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:40:34', '2021-03-11 14:40:34'),
(10862, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Application is still in process.', NULL, NULL, '2021-03-11 14:40:42', '2021-03-11 14:40:42'),
(10863, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Thank you.  This has been submitted for review; please allow 30 days.', NULL, NULL, '2021-03-11 14:40:52', '2021-03-11 14:40:52'),
(10864, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Please find the attached the page 7 that you requested.  If you anything else please call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:41:00', '2021-03-11 14:41:00'),
(10865, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Afternoon,  Hope you are doing well. Disregard the previous form page no 7 that was mistakenly submitted. Please find the attached the new Consent and Release form for Eder Francisco Hernandez.  If you need the further information please feel free to call or email me. Waiting to hear from you soon.  Thanks', NULL, NULL, '2021-03-11 14:41:11', '2021-03-11 14:41:11'),
(10866, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from : KMoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Good Morning,  Please look at page 7 on the cred app. Our credentialing department needs an explanation for answering YES to DEA Registration.  Please provide me that explanation along with a new signed Consent and Release Form.', NULL, NULL, '2021-03-11 14:41:20', '2021-03-11 14:41:20'),
(10867, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email rcvd from: KMoten4@humana.com  Subject; Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  I am inquiring on what information is missing, once I receive a response, I will let you know.  Thank you.', NULL, NULL, '2021-03-11 14:41:29', '2021-03-11 14:41:29'),
(10868, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Follow up email sent', NULL, NULL, '2021-03-11 14:41:38', '2021-03-11 14:41:38'),
(10869, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Email sent to: kmoten4@humana.com  Subject:  Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks ', NULL, NULL, '2021-03-11 14:41:47', '2021-03-11 14:41:47'),
(10870, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Follow up email sent to KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you are doing well.  Please update me regarding the status for the below provider.    Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852   Group Name: Valley Med Urgent Care Group Tax-ID: 81-5123542  If you need any additional information please feel free to email me. Looking forward to hearing from you soon.  Thanks    ', NULL, NULL, '2021-03-11 14:41:55', '2021-03-11 14:41:55'),
(10871, 3040, 19668, NULL, '2021-03-18 00:00:00.000', 'In Process', 'Follow up email to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Greetings,  Hope you will find this email in good health. Please note that we didn\'t received any email from the credentialing department that you mentioned in your previous email.   Please send me the email for the credentialing department if you want me pursue with the application.    For further queries please feel free to contact me or email me. Looking forward to hear from you soon.   Thanks', NULL, NULL, '2021-03-11 14:42:04', '2021-03-11 14:42:04'),
(10872, 3040, 19668, NULL, '2021-04-22 00:00:00.000', 'In Process', 'Email sent to: KMoten4@humana.com  Subject: Enroll Status Update (Hernandez, Eder Francisco)-(Valley Med Urgent Care)-(Tricare)  Hello Katherine,   Hope you are doing well. Please advise me the status for additional location for the below mentioned provider. Also I need the effective date.   Practice Name: Valley Med Urgent Care (All three locations) Practice Tax-ID: 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider Name: Hernandez, Eder Francisco (Provider is not showing on portal) Provider NPI# 1386956852 Additional Location: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-04-15 13:57:52', '2021-04-15 13:57:52'),
(10873, 3040, 19668, NULL, '2021-05-12 00:00:00.000', 'Approved', 'Provider participating with Tricare.   Approval confirmation attached. ', NULL, NULL, '2021-05-05 10:54:17', '2021-05-05 10:54:17'),
(10874, 1006, 19669, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 14:54:21', '2021-03-11 14:54:21'),
(10875, 1006, 19669, NULL, '2021-03-18 00:00:00.000', 'Initiated', 'The request has been submitted for enrollment online via POSC: Here is your Application Tracking Number (ATN): 204607', NULL, NULL, '2021-03-11 14:54:58', '2021-03-11 14:54:58'),
(10876, 1006, 19669, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following reply from MassHealth @ Cherif, Hawa HawaCherif@maximus.com: \"Good Morning,     This is Hawa from MassHealth reaching out in regards to your Application for  Edmundson , Rodesia  ATN 204607     - We have received an initial application via the Provider Online Service Center (POSC), however  additional information is required. Please complete the required sections of the paper application  for Medical Practitioners (PE-MP).     - Section 4 (Applicant Disclosures) of the Medical Practitioner Application must be completed in it\'s  entirety. Please resubmit Section 4 with all questions answered. Include your name and Application  Tracking Number (ATN) at the top of each page.  - The MassHealth Provider Contract for Individuals is required. The form must be signed by the  individual applicant.  - The Federally Required Disclosures form for Individual Practitioners (PE-FRD-IN) is required.  The form must be completed in its entirety.  Please note that you are not a MassHealth provider until a completed application has been approved.  Therefore, MassHealth cannot pay for services provided before the effective date of an approved  MassHealth contract.  I Will be attaching All the forms to complete, please make sure to complete and send it to me ASP.  Looking forward to hearing from you soon,  Thank you.\"  Forms were filled out and sent back to Hawa.', NULL, NULL, '2021-03-22 11:48:36', '2021-03-22 11:48:36'),
(10877, 1006, 19669, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Submitted signed documents to Hawa @ \"Cherif, Hawa\" HawaCherif@maximus.com:  Sub: MassHealth Application Edmundson Rodesia ATN 204607  \"Hello Hawa,   I apologize for the delay I was waiting on her to send me the signed files, please take a look and let me know if there\'s anything else you need from me.   Thank you.\"', NULL, NULL, '2021-04-01 09:20:35', '2021-04-01 09:20:35'),
(10878, 1019, 19669, NULL, '2021-04-09 00:00:00.000', 'New/Not Initiated', 'Sent the email to Hawa @ \"Cherif, Hawa\" HawaCherif@maximus.com:  Hello Hawa, Is there any other stuff you need from us for Rodesia Edmundson, also if everything has been delivered to you regarding these providers, also let me know the time frame to complete these enrollments. I will appreciate it if you will get back to me ASAP.  Regards, Alex', NULL, NULL, '2021-04-02 09:17:28', '2021-04-02 09:17:28'),
(10879, 1019, 19669, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Sent the following email  to hawa: HawaCherif@maximus.com  Sub: MassHealth Application Edmundson Rodesia ATN 204607  Thanks Hawa for getting back to me, please let me know how much time it will take to enroll, or if we can expedite this case as it is quite urgent because we have a lot os Masshealth patient on our waitlist.  Thank you.', NULL, NULL, '2021-04-02 09:42:43', '2021-04-02 09:42:43'),
(10880, 1019, 19669, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from: HawaCherif@maximus.com Good Morning,     This provider will be enrolled once they are data entered.  A Welcome letter will be mailed out in a few weeks as well.     Thank you.', NULL, NULL, '2021-04-05 08:24:51', '2021-04-05 08:24:51'),
(10881, 1019, 19669, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Sent the following email to HawaCherif@maximus.com  Hello Hawa,Hope you are doing well, can you please let me know the status about the enrollment process for Rodesia Edmundson under our group. Group Information:Spectrum Neuro Behavioral Care NPI: 1356906572Tax ID: 834482753 Individual Provider: Edmundson, Rodesia Sharese NPI: 1124622667 Regards,Alex', NULL, NULL, '2021-04-09 10:28:11', '2021-04-09 10:28:11'),
(10882, 1019, 19669, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to :MaribelPerezLorenzo@maximus.com, KyleRippstein@maximus.com, RobertDWint@maximus.com   Hello, Can you please let us know about the status for the enrollments under our group for the below mentioned providers.  Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753 NPI# 1356906572  Provider Name: Lynnetta Loveland NPI# 1598163602 Provider Name: Barbara Hignite NPI# 1982617262 Provider Name: Rodesia Edmundson NPI# 1124622667  Regards, Alex', NULL, NULL, '2021-04-14 10:34:37', '2021-04-14 10:34:37'),
(10883, 1019, 19669, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Welcome letter received effective date 04/05/2021 ', NULL, NULL, '2021-04-15 11:59:42', '2021-04-15 11:59:42'),
(10884, 1006, 19670, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 14:54:23', '2021-03-11 14:54:23'),
(10885, 1006, 19670, NULL, '2021-03-18 00:00:00.000', 'Initiated', 'The request has been submitted for enrollment online via POSC: Here is your Application Tracking Number (ATN): 204606', NULL, NULL, '2021-03-11 14:55:25', '2021-03-11 14:55:25'),
(10886, 1006, 19670, NULL, '2021-03-29 00:00:00.000', 'In Process', 'Received the following email from MassHealth @ Scripps, Corinne A CorinneScripps@maximus.com: \"Good Afternoon,  My name is Corinne from Masshealth Provider Enrollment and Credentialing. I am currently processing the Provider Application for Barbara Hignite, however there are some issues that require your immediate attention:  The MassHealth Provider Contract for Individuals is required. The form must be signed by the individual applicant. The Federally Required Disclosures form for Individual Practitioners (PE-FRD-IN) is required. The form must be completed in its entirety. The Data Collection Form (DCF) is required. This form must be filled out in its entirety. We have received an initial application via the Provider Online Service Center (POSC), however additional information is required. Please complete the required sections of the paper application for Medical Practitioners (PE-MP). Section 4 (Applicant Disclosures) of the Medical Practitioner Application must be completed in it\'s entirety. Please resubmit Section 4 with all questions answered. Include your name and Application Tracking Number (ATN) at the top of each page. The Group Practice PID/SL in Section 3.1 of the Medical Practitioner Application is missing or incorrect. Please resubmit this section of the application with a valid Group Practice PID/SL. Section 1.3 of the Medical Practitioner Application (Medicaid Information for Other States) is incomplete. Please resubmit this section of the Medical Practitioner Application. If Yes answered, complete the information below. The Legal/Home address on Section 1.2 of the Medical Practitioner Application is missing or incomplete. Please enter your complete home address in this section. PO Boxes are not acceptable.   Please fill out the attached forms in their entirety.  Once the necessary documents are received, I can have this provider’s application processed as soon as possible.  If you have any questions, please let me know as soon as you can.  Corinne Scripps Provider Enrollment Coordinator,  MASSHEALTH 55 Summer Street, 8th Floor Boston, MA 02110  Phone: 857-400-2306 Email: Corinnescripps@maximus.com\"  Informed her to send us the form so we can fill them out and send it back to her. ', NULL, NULL, '2021-03-22 13:11:53', '2021-03-22 13:11:53'),
(10887, 1006, 19670, NULL, '2021-03-30 00:00:00.000', 'In Process', 'Sent following reply @ \"Scripps, Corinne A\" CorinneScripps@maximus.com:  \"Hello, Corinne   Appreciate the prompt response, here are all the requested documents please let me know if anything is missing and what the next steps are.   Thank you. \"', NULL, NULL, '2021-03-23 09:26:55', '2021-03-23 09:26:55'),
(10888, 1019, 19670, NULL, '2021-04-07 00:00:00.000', 'In Process', 'Sent the documents again to Corrinne because as per my conversation with her, she was saying that the paperwork were blank. Ref# Corrinne 03/31/2021', NULL, NULL, '2021-03-31 16:02:14', '2021-03-31 16:02:14'),
(10889, 1019, 19670, NULL, '2021-04-08 00:00:00.000', 'In Process', 'Sent the following email to Corrinne at CorinneScripps@maximus.com  Hello Corinne A, Apologize for the inconvenience that we sent the blank form to you, I have attached the completed form now, Let me know if anything else is required. ', NULL, NULL, '2021-04-01 11:16:57', '2021-04-01 11:16:57'),
(10890, 1019, 19670, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Spoke with Corrinne at (857) 400-2306. She said that she will start to review  our application regarding Barbara Hignite, and she will let us know if any further action we have take on that application or not by email . Ref # Corrinne 04/02/2021.', NULL, NULL, '2021-04-02 09:14:08', '2021-04-02 09:14:08'),
(10891, 1019, 19670, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Received the following email from : CorinneScripps@maximus.com  Sub: MassHealth Provider Enrollment I have reviewed the application materials and nothing more is needed at this time for the provider.   ', NULL, NULL, '2021-04-02 10:56:38', '2021-04-02 10:56:38'),
(10892, 1019, 19670, NULL, '2021-04-09 00:00:00.000', 'In Process', 'Sent the following email to : CorinneScripps@maximus.com Thank you Corrinne, for getting back to me, please let me know how much time it will take to enroll, or if we can expedite this case as it is quite urgent because we have a lot of Masshealth patients on our waitlist.  Regards', NULL, NULL, '2021-04-02 10:57:30', '2021-04-02 10:57:30'),
(10893, 1019, 19670, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following message from : CorinneScripps@maximus.com Good Morning,     Typically applications take about 2 weeks to complete after all information has been received.  Corinne Scripps Provider Enrollment Coordinator', NULL, NULL, '2021-04-05 08:16:36', '2021-04-05 08:16:36'),
(10894, 1019, 19670, NULL, '2021-04-12 00:00:00.000', 'In Process', 'Received the following email for Corrinne  Good Morning,     I received feedback on the application materials for Barbara Hignite and we will need her to resign the application and FRDF as they are electronically signed. Please get the last page of each back to me as soon as possible, I understand that you are trying to get her accredited as soon as possible so the sooner you get these back to me the sooner we can fully complete her application.  Corinne Scripps Provider Enrollment Coordinator', NULL, NULL, '2021-04-05 15:08:58', '2021-04-05 15:08:58'),
(10895, 1019, 19670, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Received the following email for Corrinne.  Good Morning,   I received feedback on the application materials for Barbara Hignite and we will need her to resign the application and FRDF as they are electronically signed. Please get the last page of each back to me as soon as possible, I understand that you are trying to get her accredited as soon as possible so the sooner you get these back to me the sooner we can fully complete her application.  Corinne Scripps Provider Enrollment Coordinator', NULL, NULL, '2021-04-06 14:36:28', '2021-04-06 14:36:28'),
(10896, 1019, 19670, NULL, '2021-04-13 00:00:00.000', 'In Process', 'Sent the following email to Corrinne.  Hello Corrinne, As you requested I have re-signed these documents, by the provider, please process it ASAP, also let me know if anything else is required.   Regards, Alex', NULL, NULL, '2021-04-06 14:37:22', '2021-04-06 14:37:22'),
(10897, 1019, 19670, NULL, '2021-04-16 00:00:00.000', 'In Process', 'Sent the following email to CorinneScripps@maximus.com  Hello Corrine, Hope you are doing well, can you please let me know the status about the enrollment process for Barbara Hignite under our group. Group Information:Spectrum Neuro Behavioral Care NPI: 1356906572Tax ID: 834482753 Barbara Hignite NPI: 1982617262  Regards,Alex', NULL, NULL, '2021-04-09 10:21:46', '2021-04-09 10:21:46'),
(10898, 1019, 19670, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Sent the following email to :MaribelPerezLorenzo@maximus.com, KyleRippstein@maximus.com, RobertDWint@maximus.com   Hello, Can you please let us know about the status for the enrollments under our group for the below mentioned providers.  Group Name: Spectrum Neuro Behavioral Care LLC TIN# 83-4482753 NPI# 1356906572  Provider Name: Lynnetta Loveland NPI# 1598163602 Provider Name: Barbara Hignite NPI# 1982617262 Provider Name: Rodesia Edmundson NPI# 1124622667  Regards, Alex', NULL, NULL, '2021-04-14 10:34:17', '2021-04-14 10:34:17'),
(10899, 1019, 19670, NULL, '2021-04-22 00:00:00.000', 'Approved', 'Welcome letter received effective date 04/05/2021 ', NULL, NULL, '2021-04-15 12:01:20', '2021-04-15 12:01:20'),
(10900, 3046, 19671, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:43:46', '2021-03-11 15:43:46'),
(10901, 9057, 19671, NULL, '2021-06-08 00:00:00.000', 'Initiated', 'We sent an email to: providerservices@renaissancefamily.com Sub: Requisition of Enrollment - BAQC - Renaissance Physicians Hello, Hope you are doing well, We wish to enroll our group and providers, find details given below.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Provider Name: Francis, William: NPI# 1457994436  If you need any more details, please let me know.  Thank you ', NULL, NULL, '2021-06-01 08:52:42', '2021-06-01 08:52:42'),
(10902, 1006, 19671, NULL, '2021-06-16 00:00:00.000', 'Approved', 'As per my discussion with Aetna rep (Kim) the provider effective with Aetna as of 02/05/2020.   Ref# 6023625762', NULL, NULL, '2021-06-09 08:59:28', '2021-06-09 08:59:28'),
(10903, 3046, 19672, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:46:48', '2021-03-11 15:46:48'),
(10904, 9057, 19672, NULL, '2021-06-07 00:00:00.000', 'Approved', 'The ancillary contract is already in place, no need to individually add providers.   Eff: 02/15/2018', NULL, NULL, '2021-05-31 08:42:26', '2021-05-31 08:42:26'),
(10905, 3046, 19673, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:47:04', '2021-03-11 15:47:04'),
(10906, 9057, 19673, NULL, '2021-06-07 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetter  Hello, We wanted to know the current status of our providers enrollment in \'Ambetter\'   Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Francis, William NPI# 1457994436  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 10:41:18', '2021-05-31 10:41:18'),
(10907, 1006, 19673, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:34', '2021-06-15 12:03:34');
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
(10908, 1006, 19673, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference.', NULL, NULL, '2021-07-02 10:57:57', '2021-07-02 10:57:57'),
(10909, 1006, 19673, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub; MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 14:36:00', '2021-07-23 14:36:00'),
(10910, 1006, 19673, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:58:24', '2021-08-10 12:58:24'),
(10911, 11056, 19673, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 08:53:43', '2021-08-20 08:53:43'),
(10912, 11056, 19673, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 09:32:16', '2021-08-30 09:32:16'),
(10913, 11056, 19673, NULL, '2021-09-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub : RE: MELISSA RAMSDEN  Hello     We received your completed application on 7/2/21. Your effective date is 8/1/21 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-09-10 08:40:06', '2021-09-10 08:40:06'),
(10914, 11056, 19673, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-27 09:29:44', '2021-09-27 09:29:44'),
(10915, 11056, 19673, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 14:59:50', '2021-10-11 14:59:50'),
(10916, 11056, 19673, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:06:36', '2021-10-18 09:06:36'),
(10917, 11056, 19673, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 10:01:27', '2021-10-26 10:01:27'),
(10918, 11056, 19673, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from :SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello     Thank you for your email. However, your Account Manager can best assist you with your questions.        Find my Account Manager:  https://www.superiorhealthplan.com/providers/resources/find-my-provider-rep.html', NULL, NULL, '2021-11-04 14:42:01', '2021-11-04 14:42:01'),
(10919, 11056, 19673, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well with you. Please respond to my query at your earliest convenience.  Also, provide us with the contact no. and the Account Manager\'s email for our further assistance.  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, '2021-11-18 16:53:59', '2021-11-18 16:53:59'),
(10920, 11056, 19673, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]RE: MELISSA RAMSDEN  Hi, All of the requested information for Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 been received and they are still in the credentialing phase. Please reference ticket # 69145 if you have any questions.   Sincerely,  Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson)   ', NULL, NULL, '2021-12-01 12:06:42', '2021-12-01 12:06:42'),
(10921, 11056, 19673, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]Credentialing Updates   Hi, Both providers Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 are still being credentialed. It can take anywhere from 3 to 6 months to complete the process. The applications were received on 10/13/2021 and are still within the 3 month time frame. Please reference ticket #70273 if you have any questions.   Sincerely,       Barbara McDonald Account Manager, Provider Relations Region 7 (Harris & Jefferson)   711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Direct Line: 1 (800)656-4817 Press 1 for English or 2 for Spanish, then option #3 for Provider Relations Fax: 1-866-683-5630 AM.houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-12-08 14:25:18', '2021-12-08 14:25:18'),
(10922, 11056, 19673, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Case 70277 RE: MELISSA RAMSDEN   & RE: MELISSA RAMSDEN  [secure]Credentialing Updates   Good morning!  Hope all is well with you. Kindly, update us regarding reference ticket # 69145, and with a credentialing phase of the providers, Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-16 17:57:07', '2021-12-16 17:57:07'),
(10923, 11056, 19673, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub: [secure] RE: [secure]Credentialing Updates   Hello Talha,     I hope this email finds you well. I reviewed both providers and am reflecting them to be in the credentialing process. Please take note credentialing review can take up to 90 days for completion.     Cynthia Malowitz- 1336173244 shows to be under review for 64 days  Kynda Orsak – 1528553724 shows to be under review for 64 days     Thank you,     Patricia Torres  Provider Account Manager II 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2021-12-22 17:13:51', '2021-12-22 17:13:51'),
(10924, 19067, 19673, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers and group as well.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Provider Name	NPI	Location Kynda Orsak	1528553724	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418 Cynthia Malowitz	1336173244	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-28 16:48:31', '2021-12-28 16:48:31'),
(10925, 19067, 19673, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Under credentialing review  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,', NULL, NULL, '2022-01-03 14:19:51', '2022-01-03 14:19:51'),
(10926, 19067, 19673, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello!  Hope this email finds you well.  Can you please advise how much time it will take to get the contract done?  Thank you, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:34:17', '2022-01-09 19:34:17'),
(10927, 19067, 19673, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope this email finds you well.  Any updates on this?    Regards. ', NULL, NULL, '2022-01-14 10:13:07', '2022-01-14 10:13:07'),
(10928, 19067, 19673, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||     Hello Ahmed,     I hope this email finds you well. Providers being added to an existing group requests can take up 120 days for processing. Credentialing review can take up to 90 days for processing, once approved provider is then configured into the system which can take to another 30 days for processing. Total processing up to 120 days.     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-01-20 18:37:30', '2022-01-20 18:37:30'),
(10929, 19067, 19673, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope you\'re having a productive day.  Any updates on the credentialing process of the previously mentioned providers?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:15:40', '2022-02-08 11:15:40'),
(10930, 19067, 19673, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  I haven\'t heard from you in awhile. Kindly respond to my request below.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-15 10:46:11', '2022-02-15 10:46:11'),
(10931, 19067, 19673, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hi,  Your email has been received and an Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Ticket # 80437.     Regards.     Barbara McDonald  Provider Account Manager  Region 7 (Harris & Jefferson)   ', NULL, NULL, '2022-02-15 14:41:51', '2022-02-15 14:41:51'),
(10932, 19067, 19673, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-02-18 14:47:25', '2022-02-18 14:47:25'),
(10933, 19067, 19673, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II    711 N Carancahua Street, Ste. 600  Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3  Fax: 1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2022-02-21 09:52:07', '2022-02-21 09:52:07'),
(10934, 19067, 19673, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  Can I get the welcome kit for the providers?  Thanks,', NULL, NULL, '2022-03-09 11:18:50', '2022-03-09 11:18:50'),
(10935, 19067, 19673, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    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 #84362.      If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team.     Thank you,     Melinda Mendoza Account Manager  Provider Relations Department    711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401  Tolll-Free:  1-800-656-4817 Option 1 then Option 3  Fax:  1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-10 10:42:18', '2022-03-10 10:42:18'),
(10936, 19067, 19673, NULL, '2022-04-07 00:00:00.000', 'Approved', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [Secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  KYNDA ORSAK, NPI:  1528553724 Effective Date:  03/01/2022 Welcome letter is process of being generated to be sent out.  Process may take up to 30 days after effective date of 03/01/2022.    CYNTHIA MALOWITZ, NPI 1336173244 Effective Date:  04/01/2022 Welcome letter will be generated after effective date 04/01/2022.  Please allow for letter to be generated and sent out.  Process may take up to 30 days after effective date.  Thank you,    Yvette Hernandez Account Manager Provider Relations Department   711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401 Toll-Free:  1-800-656-4817 Option 1 then Option 3 Fax:  1-866-683-5630 AM.Houston@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-31 10:46:23', '2022-03-31 10:46:23'),
(10937, 3046, 19674, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:51:59', '2021-03-11 15:51:59'),
(10938, 9057, 19674, NULL, '2021-06-07 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetter  Hello, We wanted to know the current status of our providers enrollment in \'Ambetter\'   Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Francis, William NPI# 1457994436  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 10:39:46', '2021-05-31 10:39:46'),
(10939, 1006, 19674, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:28', '2021-06-15 12:03:28'),
(10940, 1006, 19674, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference.', NULL, NULL, '2021-07-02 10:57:26', '2021-07-02 10:57:26'),
(10941, 1006, 19674, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub; MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 14:35:51', '2021-07-23 14:35:51'),
(10942, 1006, 19674, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:58:21', '2021-08-10 12:58:21'),
(10943, 11056, 19674, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 08:53:32', '2021-08-20 08:53:32'),
(10944, 11056, 19674, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 09:32:03', '2021-08-30 09:32:03'),
(10945, 11056, 19674, NULL, '2021-09-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub : RE: MELISSA RAMSDEN  Hello     We received your completed application on 7/2/21. Your effective date is 8/1/21 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-09-10 08:40:01', '2021-09-10 08:40:01'),
(10946, 11056, 19674, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-27 09:29:34', '2021-09-27 09:29:34'),
(10947, 11056, 19674, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 14:59:44', '2021-10-11 14:59:44'),
(10948, 11056, 19674, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:06:28', '2021-10-18 09:06:28'),
(10949, 11056, 19674, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 10:01:22', '2021-10-26 10:01:22'),
(10950, 11056, 19674, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from :SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello     Thank you for your email. However, your Account Manager can best assist you with your questions.        Find my Account Manager:  https://www.superiorhealthplan.com/providers/resources/find-my-provider-rep.html', NULL, NULL, '2021-11-04 14:41:55', '2021-11-04 14:41:55'),
(10951, 11056, 19674, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well with you. Please respond to my query at your earliest convenience.  Also, provide us with the contact no. and the Account Manager\'s email for our further assistance.  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, '2021-11-18 16:53:53', '2021-11-18 16:53:53'),
(10952, 11056, 19674, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]RE: MELISSA RAMSDEN  Hi, All of the requested information for Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 been received and they are still in the credentialing phase. Please reference ticket # 69145 if you have any questions.   Sincerely,  Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson)   ', NULL, NULL, '2021-12-01 12:06:47', '2021-12-01 12:06:47'),
(10953, 11056, 19674, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]Credentialing Updates   Hi, Both providers Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 are still being credentialed. It can take anywhere from 3 to 6 months to complete the process. The applications were received on 10/13/2021 and are still within the 3 month time frame. Please reference ticket #70273 if you have any questions.   Sincerely,       Barbara McDonald Account Manager, Provider Relations Region 7 (Harris & Jefferson)   711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Direct Line: 1 (800)656-4817 Press 1 for English or 2 for Spanish, then option #3 for Provider Relations Fax: 1-866-683-5630 AM.houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-12-08 14:25:13', '2021-12-08 14:25:13'),
(10954, 11056, 19674, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Case 70277 RE: MELISSA RAMSDEN   & RE: MELISSA RAMSDEN  [secure]Credentialing Updates   Good morning!  Hope all is well with you. Kindly, update us regarding reference ticket # 69145, and with a credentialing phase of the providers, Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-16 17:56:59', '2021-12-16 17:56:59'),
(10955, 11056, 19674, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub: [secure] RE: [secure]Credentialing Updates   Hello Talha,     I hope this email finds you well. I reviewed both providers and am reflecting them to be in the credentialing process. Please take note credentialing review can take up to 90 days for completion.     Cynthia Malowitz- 1336173244 shows to be under review for 64 days  Kynda Orsak – 1528553724 shows to be under review for 64 days     Thank you,     Patricia Torres  Provider Account Manager II 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2021-12-22 17:13:46', '2021-12-22 17:13:46'),
(10956, 19067, 19674, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers and group as well.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Provider Name	NPI	Location Kynda Orsak	1528553724	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418 Cynthia Malowitz	1336173244	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-28 16:48:16', '2021-12-28 16:48:16'),
(10957, 19067, 19674, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Under credentialing review  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,', NULL, NULL, '2022-01-03 14:19:54', '2022-01-03 14:19:54'),
(10958, 19067, 19674, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello!  Hope this email finds you well.  Can you please advise how much time it will take to get the contract done?  Thank you, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:34:11', '2022-01-09 19:34:11'),
(10959, 19067, 19674, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope this email finds you well.  Any updates on this?    Regards. ', NULL, NULL, '2022-01-14 10:13:05', '2022-01-14 10:13:05'),
(10960, 19067, 19674, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||     Hello Ahmed,     I hope this email finds you well. Providers being added to an existing group requests can take up 120 days for processing. Credentialing review can take up to 90 days for processing, once approved provider is then configured into the system which can take to another 30 days for processing. Total processing up to 120 days.     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-01-20 18:37:20', '2022-01-20 18:37:20'),
(10961, 19067, 19674, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope you\'re having a productive day.  Any updates on the credentialing process of the previously mentioned providers?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:15:53', '2022-02-08 11:15:53'),
(10962, 19067, 19674, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  I haven\'t heard from you in awhile. Kindly respond to my request below.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-15 10:46:16', '2022-02-15 10:46:16'),
(10963, 19067, 19674, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hi,  Your email has been received and an Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Ticket # 80437.     Regards.     Barbara McDonald  Provider Account Manager  Region 7 (Harris & Jefferson)   ', NULL, NULL, '2022-02-15 14:41:45', '2022-02-15 14:41:45'),
(10964, 19067, 19674, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-02-18 14:47:30', '2022-02-18 14:47:30'),
(10965, 19067, 19674, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II    711 N Carancahua Street, Ste. 600  Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3  Fax: 1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2022-02-21 09:52:13', '2022-02-21 09:52:13'),
(10966, 19067, 19674, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  Can I get the welcome kit for the providers?  Thanks,', NULL, NULL, '2022-03-09 11:18:56', '2022-03-09 11:18:56'),
(10967, 19067, 19674, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    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 #84362.      If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team.     Thank you,     Melinda Mendoza Account Manager  Provider Relations Department    711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401  Tolll-Free:  1-800-656-4817 Option 1 then Option 3  Fax:  1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-10 10:42:22', '2022-03-10 10:42:22'),
(10968, 19067, 19674, NULL, '2022-04-07 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [Secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  KYNDA ORSAK, NPI:  1528553724 Effective Date:  03/01/2022 Welcome letter is process of being generated to be sent out.  Process may take up to 30 days after effective date of 03/01/2022.    CYNTHIA MALOWITZ, NPI 1336173244 Effective Date:  04/01/2022 Welcome letter will be generated after effective date 04/01/2022.  Please allow for letter to be generated and sent out.  Process may take up to 30 days after effective date.  Thank you,    Yvette Hernandez Account Manager Provider Relations Department   711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401 Toll-Free:  1-800-656-4817 Option 1 then Option 3 Fax:  1-866-683-5630 AM.Houston@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-31 10:47:43', '2022-03-31 10:47:43'),
(10969, 22077, 19674, NULL, '2022-04-27 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: 	Re: [secure] RE: [Secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hi,  Can I get the welcome letter for the group & providers, Cynthia Malowitz & Kynda Orsak?  Thanks & Regards. ', NULL, NULL, '2022-04-20 13:01:08', '2022-04-20 13:01:08'),
(10970, 3046, 19675, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:53:03', '2021-03-11 15:53:03'),
(10971, 9057, 19675, NULL, '2021-06-07 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetter  Hello, We wanted to know the current status of our providers enrollment in \'Ambetter\'   Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Francis, William NPI# 1457994436  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 10:43:23', '2021-05-31 10:43:23'),
(10972, 1006, 19675, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:24', '2021-06-15 12:03:24'),
(10973, 1006, 19675, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference.', NULL, NULL, '2021-07-02 10:57:54', '2021-07-02 10:57:54'),
(10974, 1006, 19675, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub; MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 14:35:56', '2021-07-23 14:35:56'),
(10975, 1006, 19675, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:58:17', '2021-08-10 12:58:17'),
(10976, 11056, 19675, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 08:53:24', '2021-08-20 08:53:24'),
(10977, 11056, 19675, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 09:31:51', '2021-08-30 09:31:51'),
(10978, 11056, 19675, NULL, '2021-09-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub : RE: MELISSA RAMSDEN  Hello     We received your completed application on 7/2/21. Your effective date is 8/1/21 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-09-10 08:39:55', '2021-09-10 08:39:55'),
(10979, 11056, 19675, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-27 09:29:29', '2021-09-27 09:29:29'),
(10980, 11056, 19675, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 14:59:37', '2021-10-11 14:59:37'),
(10981, 11056, 19675, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:06:23', '2021-10-18 09:06:23'),
(10982, 11056, 19675, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 10:01:16', '2021-10-26 10:01:16'),
(10983, 11056, 19675, NULL, '2021-11-02 00:00:00.000', 'Not Eligible', 'Please mark there task to Not Eligible so we can avoid errors and save time, also if you get any approval for them they will counted  Please see the attachment too.', NULL, NULL, '2021-10-26 10:41:47', '2021-10-26 10:41:47'),
(10984, 3046, 19676, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:54:06', '2021-03-11 15:54:06'),
(10985, 9057, 19676, NULL, '2021-06-07 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetter  Hello, We wanted to know the current status of our providers enrollment in \'Ambetter\'   Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Francis, William NPI# 1457994436  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 10:40:22', '2021-05-31 10:40:22'),
(10986, 1006, 19676, NULL, '2021-06-22 00:00:00.000', 'Not Eligible', 'The provider is no longer active with the group.', NULL, NULL, '2021-06-15 11:47:34', '2021-06-15 11:47:34'),
(10987, 1006, 19676, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:17', '2021-06-15 12:03:17'),
(10988, 1006, 19676, NULL, '2021-07-09 00:00:00.000', 'Not Eligible', '', NULL, NULL, '2021-07-02 09:30:58', '2021-07-02 09:30:58'),
(10989, 3046, 19677, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 15:56:37', '2021-03-11 15:56:37'),
(10990, 9057, 19677, NULL, '2021-06-07 00:00:00.000', 'In Process', 'we sent an email to credentialing@superiorhealthplan.com Sub: Enrollment status request - RHC - Ambetter  Hello, We wanted to know the current status of our providers enrollment in \'Ambetter\'   Group Details Group Name: Bay Area Quick Care PLLC TIN# 27-1702009 NPI# 1437481421 Group Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148  Provider Name: Francis, William NPI# 1457994436  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 10:40:50', '2021-05-31 10:40:50'),
(10991, 1006, 19677, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Left voicemail @ (877) 687-1196 asking for enrollment updates as we\'re not getting any updates through the email.  ', NULL, NULL, '2021-06-15 12:03:07', '2021-06-15 12:03:07'),
(10992, 1006, 19677, NULL, '2021-07-09 00:00:00.000', 'In Process', 'We rcvd the following reply from SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"We received your signed contract. However, we have not received your Credentialing Application packet. Attached is the email that was sent. Please complete the forms & return along with a copy of your current W9 so that we can start the process.  Thank you, Leslie Gilchrist Intake Coordinator Contract Management\"  Replied with:  \"Hello Leslie,  Please find the requested documents attached, do let me know if anything else is required.  Thank you. \"  The ancillary contracting request is attached in the main group task for reference.', NULL, NULL, '2021-07-02 10:57:51', '2021-07-02 10:57:51'),
(10993, 1006, 19677, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Sent f/u email @ SHP-Network Development SHP.NetworkDevelopment@superiorhealthplan.com:  Sub; MELISSA RAMSDEN  \"Hello,   I wanted to get an update regarding the enrollment status for our provider. Please get back to me as soon as possible.  Thank you. \"', NULL, NULL, '2021-07-23 14:36:04', '2021-07-23 14:36:04'),
(10994, 1006, 19677, NULL, '2021-08-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub: MELISSA RAMSDEN  \"Hello,  We received your completed application on July 2, 2021 Your projected effective date is August 1, 2021. Currently, it is in the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Sincerely,  Lucy Escobar Lead Contracts Coordinatoor, Contract Management\"  Need to allow more time for it to process and complete. ', NULL, NULL, '2021-08-10 12:58:13', '2021-08-10 12:58:13'),
(10995, 11056, 19677, NULL, '2021-08-27 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello,   I appreciate the update, I just wanted to confirm what the status for the ancillary contract is as well?  Thank you. ', NULL, NULL, '2021-08-20 08:53:15', '2021-08-20 08:53:15'),
(10996, 11056, 19677, NULL, '2021-09-06 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope this email finds you well. Whenever the application is uploaded and the provider\'s enrollment is completed, please inform us. Please keep us updated with the process. Please let us know the latest status for the ancillary contract too.  If you need any document or information feel free to reach out to me. Waiting for your response.  Thank you! Have a great weekend!', NULL, NULL, '2021-08-30 09:31:35', '2021-08-30 09:31:35'),
(10997, 11056, 19677, NULL, '2021-09-17 00:00:00.000', 'In Process', 'We received the following update from SHP-NETWORKDEVELOPMENT@superiorhealthplan.com:  Sub : RE: MELISSA RAMSDEN  Hello     We received your completed application on 7/2/21. Your effective date is 8/1/21 and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-09-10 08:39:42', '2021-09-10 08:39:42'),
(10998, 11056, 19677, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-27 09:29:14', '2021-09-27 09:29:14');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(10999, 11056, 19677, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Good morning!  Hope you are doing well. We are still waiting to get the latest updates regarding the enrollment status of the below mentioned providers and practice as soon as possible. We haven\'t received the welcome packet yet.   Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi , TX 78418-5148  Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	  1336173244 Melissa Ramsden	1194376228    If you have any questions or concerns please let me know. Eagerly,waiting to get the response from you.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-27 09:29:23', '2021-09-27 09:29:23'),
(11000, 11056, 19677, NULL, '2021-10-18 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Hello  We received your completed application for Melissa Ramsden on 7/2/21. Your effective date is 8/1/21  and will be receiving a welcome packet shortly. ', NULL, NULL, '2021-10-11 14:59:31', '2021-10-11 14:59:31'),
(11001, 11056, 19677, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Please assist me with the query at your earliest convenience. Does the Superior Health plan come under Medicare or Medicaid?', NULL, NULL, '2021-10-18 09:06:16', '2021-10-18 09:06:16'),
(11002, 11056, 19677, NULL, '2021-11-02 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well. Please find the attached forms for the remaining providers mentioned below. If further information or documents are needed please let me know.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Primary Location	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418-5148 Provider Name	NPI William Francis	1457994436 Kynda Orsak	1528553724 Cynthia Malowitz	1336173244   In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-10-26 10:01:11', '2021-10-26 10:01:11'),
(11003, 11056, 19677, NULL, '2021-11-11 00:00:00.000', 'In Process', 'Email received from :SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN  Hello     Thank you for your email. However, your Account Manager can best assist you with your questions.        Find my Account Manager:  https://www.superiorhealthplan.com/providers/resources/find-my-provider-rep.html', NULL, NULL, '2021-11-04 14:41:49', '2021-11-04 14:41:49'),
(11004, 11056, 19677, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Sub : RE: MELISSA RAMSDEN   Good morning!  Hope all is well with you. Please respond to my query at your earliest convenience.  Also, provide us with the contact no. and the Account Manager\'s email for our further assistance.  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, '2021-11-18 16:53:49', '2021-11-18 16:53:49'),
(11005, 11056, 19677, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]RE: MELISSA RAMSDEN  Hi, All of the requested information for Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 been received and they are still in the credentialing phase. Please reference ticket # 69145 if you have any questions.   Sincerely,  Barbara McDonald  Account Manager, Provider Relations Region 7 (Harris & Jefferson)   ', NULL, NULL, '2021-12-01 12:06:51', '2021-12-01 12:06:51'),
(11006, 11056, 19677, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from:  AM.Houston@superiorhealthplan.com  Sub:  [secure]Credentialing Updates   Hi, Both providers Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244 are still being credentialed. It can take anywhere from 3 to 6 months to complete the process. The applications were received on 10/13/2021 and are still within the 3 month time frame. Please reference ticket #70273 if you have any questions.   Sincerely,       Barbara McDonald Account Manager, Provider Relations Region 7 (Harris & Jefferson)   711 N. Carancahua Street, Ste. 600 Corpus Christi, TX 78401 Direct Line: 1 (800)656-4817 Press 1 for English or 2 for Spanish, then option #3 for Provider Relations Fax: 1-866-683-5630 AM.houston@superiorhealthplan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-12-08 14:25:05', '2021-12-08 14:25:05'),
(11007, 11056, 19677, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email sent to: AM.Houston@superiorhealthplan.com  Sub: Case 70277 RE: MELISSA RAMSDEN   & RE: MELISSA RAMSDEN  [secure]Credentialing Updates   Good morning!  Hope all is well with you. Kindly, update us regarding reference ticket # 69145, and with a credentialing phase of the providers, Kynda Orsak NPI: 1528553724 & Cynthia Malowitz NPI: 1336173244  In the meantime, please do not hesitate to reach out if you have any questions or concerns.  Thank you! Have a great day!', NULL, NULL, '2021-12-16 17:56:54', '2021-12-16 17:56:54'),
(11008, 11056, 19677, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Sub: [secure] RE: [secure]Credentialing Updates   Hello Talha,     I hope this email finds you well. I reviewed both providers and am reflecting them to be in the credentialing process. Please take note credentialing review can take up to 90 days for completion.     Cynthia Malowitz- 1336173244 shows to be under review for 64 days  Kynda Orsak – 1528553724 shows to be under review for 64 days     Thank you,     Patricia Torres  Provider Account Manager II 711 N Carancahua Street, Ste. 600 Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2021-12-22 17:13:41', '2021-12-22 17:13:41'),
(11009, 19067, 19677, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  Hope you are doing well.  I would like to know the enrollment status of the following providers and group as well.  Group Name	Bay Area Quick Care PLLC Tax ID	27-1702009 Group NPI	1437481421 Provider Name	NPI	Location Kynda Orsak	1528553724	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418 Cynthia Malowitz	1336173244	9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418   Thanks & Regards, Ahmed, Hammad. ', NULL, NULL, '2021-12-28 16:48:23', '2021-12-28 16:48:23'),
(11010, 19067, 19677, NULL, '2022-01-10 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Under credentialing review  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,', NULL, NULL, '2022-01-03 14:19:40', '2022-01-03 14:19:40'),
(11011, 19067, 19677, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello!  Hope this email finds you well.  Can you please advise how much time it will take to get the contract done?  Thank you, Hammad Ahmed.', NULL, NULL, '2022-01-09 19:34:04', '2022-01-09 19:34:04'),
(11012, 19067, 19677, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope this email finds you well.  Any updates on this?    Regards. ', NULL, NULL, '2022-01-14 10:13:09', '2022-01-14 10:13:09'),
(11013, 19067, 19677, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||     Hello Ahmed,     I hope this email finds you well. Providers being added to an existing group requests can take up 120 days for processing. Credentialing review can take up to 90 days for processing, once approved provider is then configured into the system which can take to another 30 days for processing. Total processing up to 120 days.     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-01-20 18:37:10', '2022-01-20 18:37:10'),
(11014, 19067, 19677, NULL, '2022-02-15 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||   Greetings!  Hope you\'re having a productive day.  Any updates on the credentialing process of the previously mentioned providers?  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-08 11:15:47', '2022-02-08 11:15:47'),
(11015, 19067, 19677, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||  Hello,  I haven\'t heard from you in awhile. Kindly respond to my request below.  Regards, Hammad Ahmed.', NULL, NULL, '2022-02-15 10:46:04', '2022-02-15 10:46:04'),
(11016, 19067, 19677, NULL, '2022-02-22 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hi,  Your email has been received and an Account Manager will be contacting you to address your request. When contacting Account Management for updates on this issue, you can Reference Ticket # 80437.     Regards.     Barbara McDonald  Provider Account Manager  Region 7 (Harris & Jefferson)   ', NULL, NULL, '2022-02-15 14:41:41', '2022-02-15 14:41:41'),
(11017, 19067, 19677, NULL, '2022-02-25 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II', NULL, NULL, '2022-02-18 14:47:20', '2022-02-18 14:47:20'),
(11018, 19067, 19677, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello Ahmed,     I hope this email finds you well. See requested information below:     Kynda Orsak  1528553724  Credentialing approved 2/10/22 application still in process tentative eff date 3/1/22. Completion will take place once you receive the welcome letter  Cynthia Malowitz  1336173244  Under credentialing review     Thank you,     Patricia Torres  Provider Account Manager II    711 N Carancahua Street, Ste. 600  Corpus Christi, Tx 78401  Toll-Free: 1-800-656-4817 Option 1, then Option 3  Fax: 1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com| SuperiorHealthplan.com', NULL, NULL, '2022-02-21 09:52:02', '2022-02-21 09:52:02'),
(11019, 19067, 19677, NULL, '2022-03-16 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  Can I get the welcome kit for the providers?  Thanks,', NULL, NULL, '2022-03-09 11:18:44', '2022-03-09 11:18:44'),
(11020, 19067, 19677, NULL, '2022-03-17 00:00:00.000', 'In Process', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || BAQC || Group & Providers || Ambetter ||    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 #84362.      If you are in need of immediate assistance, you can call to speak to an Account Manager by phone at 1-800-656-4817 (English 1, Spanish 2), and Option 3  Provider Relations Team.     Thank you,     Melinda Mendoza Account Manager  Provider Relations Department    711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401  Tolll-Free:  1-800-656-4817 Option 1 then Option 3  Fax:  1-866-683-5630  AM.CorpusChristi@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-10 10:42:29', '2022-03-10 10:42:29'),
(11021, 19067, 19677, NULL, '2022-04-07 00:00:00.000', 'Approved', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Re: [Secure] RE: Enrollment Status || BAQC || Group & Providers || Ambetter ||    Hello,  KYNDA ORSAK, NPI:  1528553724 Effective Date:  03/01/2022 Welcome letter is process of being generated to be sent out.  Process may take up to 30 days after effective date of 03/01/2022.    CYNTHIA MALOWITZ, NPI 1336173244 Effective Date:  04/01/2022 Welcome letter will be generated after effective date 04/01/2022.  Please allow for letter to be generated and sent out.  Process may take up to 30 days after effective date.  Thank you,    Yvette Hernandez Account Manager Provider Relations Department   711 N. Carancahua Street, Suite 600 Corpus Christi, TX  78401 Toll-Free:  1-800-656-4817 Option 1 then Option 3 Fax:  1-866-683-5630 AM.Houston@superiorhealthplan.com |SuperiorHealthPlan.com', NULL, NULL, '2022-03-31 10:46:16', '2022-03-31 10:46:16'),
(11022, 1006, 19681, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:02:46', '2021-03-11 16:02:46'),
(11023, 3040, 19681, NULL, '2021-04-26 00:00:00.000', 'In Process', 'I had a word with (NIKKO) Aetna representative and he said that our group is participating with Aetna network. Effective Date: 02/15/2020.   We already sent the request for the copy of group contract.   Ref: 6013939899', NULL, NULL, '2021-04-19 12:49:30', '2021-04-19 12:49:30'),
(11024, 1019, 19681, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:06:50', '2021-05-20 08:06:50'),
(11025, 1019, 19681, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:56', '2021-06-16 07:57:56'),
(11026, 1019, 19681, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Effective date 02/19/2020, attached is the agreement Brad received. ', NULL, NULL, '2021-08-30 10:36:53', '2021-08-30 10:36:53'),
(11027, 1006, 19682, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:03:19', '2021-03-11 16:03:19'),
(11028, 3040, 19682, NULL, '2021-04-26 00:00:00.000', 'In Process', 'I had a word with (NIKKO) Aetna representative and he said that our group is participating with Aetna network. Effective Date: 02/15/2020.   We already sent the request for the copy of group contract.   Ref: 6013939899', NULL, NULL, '2021-04-19 12:49:35', '2021-04-19 12:49:35'),
(11029, 1019, 19682, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:07:06', '2021-05-20 08:07:06'),
(11030, 1019, 19682, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-06-16 07:57:49', '2021-06-16 07:57:49'),
(11031, 1019, 19682, NULL, '2021-09-06 00:00:00.000', 'Approved', 'Effective date 02/19/2020, attached is the agreement Brad received. ', NULL, NULL, '2021-08-30 10:36:39', '2021-08-30 10:36:39'),
(11032, 3046, 19685, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:04:55', '2021-03-11 16:04:55'),
(11033, 1006, 19685, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'The group enrollment is currently in process, check group task for further clarification. ', NULL, NULL, '2021-05-04 10:44:37', '2021-05-04 10:44:37'),
(11034, 3040, 19685, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'The group enrollment is currently in process, check group task for further clarification.  ', NULL, NULL, '2021-06-10 10:58:41', '2021-06-10 10:58:41'),
(11035, 1006, 19685, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Received following approval confirmation email from @ Offord, Tommishia S. tommishia.offord@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  \"Good morning,  Bay Area Quick Care PLLC is credentialed as a facility and would not require the providers to be credentialed individually. All billing will be under the ancillary agreement. Please reach out to your Network Contractor for an executed contract (Michal Simms). I have attached the Credentialing Approval Welcome Letter that was sent on May 12, 2021 to email address “baqc@claimsmedinc.com”. As stated in the email history, the network effective date will be 7/1/2021. Please let us know if you need anything else. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254\"  The welcome letter is attached for reference in the main group task as this is a facility contract.  ', NULL, NULL, '2021-06-16 11:51:09', '2021-06-16 11:51:09'),
(11036, 3046, 19692, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:37:58', '2021-03-11 16:37:58'),
(11037, 1006, 19692, NULL, '2021-05-20 00:00:00.000', 'Initiated', 'The group enrollment is currently in process, check group task for further clarification. ', NULL, NULL, '2021-05-04 10:46:23', '2021-05-04 10:46:23'),
(11038, 3040, 19692, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'The group enrollment is currently in process, check group task for further clarification.  ', NULL, NULL, '2021-06-10 10:58:36', '2021-06-10 10:58:36'),
(11039, 1006, 19692, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Received following approval confirmation email from @ Offord, Tommishia S. tommishia.offord@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  \"Good morning,  Bay Area Quick Care PLLC is credentialed as a facility and would not require the providers to be credentialed individually. All billing will be under the ancillary agreement. Please reach out to your Network Contractor for an executed contract (Michal Simms). I have attached the Credentialing Approval Welcome Letter that was sent on May 12, 2021 to email address “baqc@claimsmedinc.com”. As stated in the email history, the network effective date will be 7/1/2021. Please let us know if you need anything else. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254\"  The welcome letter is attached for reference in the main group task as this is a facility contract.  ', NULL, NULL, '2021-06-16 11:51:23', '2021-06-16 11:51:23'),
(11040, 3046, 19696, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:39:05', '2021-03-11 16:39:05'),
(11041, 1006, 19696, NULL, '2021-05-11 00:00:00.000', 'Initiated', 'The group enrollment is currently in process, check group task for further clarification. ', NULL, NULL, '2021-05-04 10:46:34', '2021-05-04 10:46:34'),
(11042, 3040, 19696, NULL, '2021-06-17 00:00:00.000', 'On Hold', 'The group enrollment is currently in process, check group task for further clarification.  ', NULL, NULL, '2021-06-10 10:58:30', '2021-06-10 10:58:30'),
(11043, 1006, 19696, NULL, '2021-06-23 00:00:00.000', 'Approved', 'Received following approval confirmation email from @ Offord, Tommishia S. tommishia.offord@christushealth.org:  Sub: Request for enrollment status - BAQC - CHRISTUS HEALTH PLAN  \"Good morning,  Bay Area Quick Care PLLC is credentialed as a facility and would not require the providers to be credentialed individually. All billing will be under the ancillary agreement. Please reach out to your Network Contractor for an executed contract (Michal Simms). I have attached the Credentialing Approval Welcome Letter that was sent on May 12, 2021 to email address “baqc@claimsmedinc.com”. As stated in the email history, the network effective date will be 7/1/2021. Please let us know if you need anything else. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254\"  The welcome letter is attached for reference in the main group task as this is a facility contract.  ', NULL, NULL, '2021-06-16 11:51:27', '2021-06-16 11:51:27'),
(11044, 3046, 19706, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:42:14', '2021-03-11 16:42:14'),
(11045, 9057, 19706, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We Sent an email to: intake_pdm@cigna.com Sub: Enrollment Request Status - BAQC - Cigna  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418    Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly update us with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 11:53:50', '2021-05-31 11:53:50'),
(11046, 1006, 19706, NULL, '2021-06-24 00:00:00.000', 'Approved', 'We have an urgentcare contract with Cigna, approval confirmation is attached for reference.   Cigna has an ancillary contract,  Provider ID# 8174536 Eff: 10/10/2018 Ref# Paul D 06/17/2021', NULL, NULL, '2021-06-17 12:21:33', '2021-06-17 12:21:33'),
(11047, 3046, 19713, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:46:57', '2021-03-11 16:46:57'),
(11048, 9057, 19713, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We Sent an email to: intake_pdm@cigna.com Sub: Enrollment Request Status - BAQC - Cigna  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418    Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly update us with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 11:54:14', '2021-05-31 11:54:14'),
(11049, 1006, 19713, NULL, '2021-06-24 00:00:00.000', 'Approved', 'We have an urgent care contract with Cigna, the provider is enrolled under it, approval confirmation is attached for reference in main group task.   Cigna has an ancillary contract,  Provider ID# 8174536 Eff: 10/10/2018 Ref# Paul D 06/17/2021 ', NULL, NULL, '2021-06-17 12:23:52', '2021-06-17 12:23:52'),
(11050, 3040, 19714, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:47:01', '2021-03-11 16:47:01'),
(11051, 3040, 19714, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. ', NULL, NULL, '2021-03-19 16:11:01', '2021-03-19 16:11:01'),
(11052, 3046, 19715, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:47:06', '2021-03-11 16:47:06'),
(11053, 9057, 19715, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We Sent an email to: intake_pdm@cigna.com Sub: Enrollment Request Status - BAQC - Cigna  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418    Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228  Kindly update us with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 11:54:05', '2021-05-31 11:54:05'),
(11054, 1006, 19715, NULL, '2021-06-24 00:00:00.000', 'Approved', 'We have an urgent care contract with Cigna, the provider is enrolled under it, approval confirmation is attached for reference in main group task.   Cigna has an ancillary contract,  Provider ID# 8174536 Eff: 10/10/2018 Ref# Paul D 06/17/2021 ', NULL, NULL, '2021-06-17 12:22:34', '2021-06-17 12:22:34'),
(11055, 3040, 19716, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:47:55', '2021-03-11 16:47:55'),
(11056, 3040, 19716, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers ', NULL, NULL, '2021-03-19 16:14:52', '2021-03-19 16:14:52'),
(11057, 3040, 19717, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:48:51', '2021-03-11 16:48:51'),
(11058, 3040, 19717, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-19 16:24:39', '2021-03-19 16:24:39'),
(11059, 3040, 19718, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:49:15', '2021-03-11 16:49:15'),
(11060, 3040, 19718, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider', NULL, NULL, '2021-03-19 16:27:33', '2021-03-19 16:27:33'),
(11061, 3046, 19719, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:49:25', '2021-03-11 16:49:25'),
(11062, 9057, 19719, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', '\"Hold off on Driscoll for now.  The reason is because there’s a doctor on their Board named Dr Buck, and he hates NPs.  A friend got credentialed with them and he wrote her a letter demanding a copy of her collaborating agreement with a physician - he told her that if she didn’t give it to him within three days, he was going to report both her and the doctor to the Board.  After they credentialed her, she told them to forget it, knowing that Dr Buck would cause trouble.  Unfortunately, Dr Buck lives in CC and causes trouble for NPs, especially if they own their own clinic. ', NULL, NULL, '2021-05-31 16:15:59', '2021-05-31 16:15:59'),
(11063, 3046, 19720, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:49:57', '2021-03-11 16:49:57'),
(11064, 9057, 19720, NULL, '2021-06-08 00:00:00.000', 'In Process', 'We sent an email to: DHPContracting@dchstx.org Sub: Request for Enrollment Status - BAQC - Driscoll  Hello, I want to get the current status of the below mentioned provider under the following group.  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Francis, William NPI# 1457994436  Kindly respond to us as soon as possible.  Thank you', NULL, NULL, '2021-05-31 16:13:15', '2021-05-31 16:13:15'),
(11065, 9057, 19720, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', '\"Hold off on Driscoll for now.  The reason is because there’s a doctor on their Board named Dr Buck, and he hates NPs.  A friend got credentialed with them and he wrote her a letter demanding a copy of her collaborating agreement with a physician - he told her that if she didn’t give it to him within three days, he was going to report both her and the doctor to the Board.  After they credentialed her, she told them to forget it, knowing that Dr Buck would cause trouble.  Unfortunately, Dr Buck lives in CC and causes trouble for NPs, especially if they own their own clinic. ', NULL, NULL, '2021-05-31 16:15:02', '2021-05-31 16:15:02'),
(11066, 3046, 19721, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:50:14', '2021-03-11 16:50:14'),
(11067, 9057, 19721, NULL, '2021-06-08 00:00:00.000', 'In Process', 'We sent an email to: DHPContracting@dchstx.org Sub: Request for Enrollment Status - BAQC - Driscoll  Hello, I want to get the current status of the below mentioned provider under the following group.  Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Francis, William NPI# 1457994436  Kindly respond to us as soon as possible.  Thank you  ', NULL, NULL, '2021-05-31 16:12:43', '2021-05-31 16:12:43'),
(11068, 9057, 19721, NULL, '2021-06-08 00:00:00.000', 'Not Eligible', '\"Hold off on Driscoll for now.  The reason is because there’s a doctor on their Board named Dr Buck, and he hates NPs.  A friend got credentialed with them and he wrote her a letter demanding a copy of her collaborating agreement with a physician - he told her that if she didn’t give it to him within three days, he was going to report both her and the doctor to the Board.  After they credentialed her, she told them to forget it, knowing that Dr Buck would cause trouble.  Unfortunately, Dr Buck lives in CC and causes trouble for NPs, especially if they own their own clinic. ', NULL, NULL, '2021-05-31 16:14:32', '2021-05-31 16:14:32'),
(11069, 3040, 19722, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:50:57', '2021-03-11 16:50:57'),
(11070, 3040, 19722, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. ', NULL, NULL, '2021-03-19 16:11:08', '2021-03-19 16:11:08'),
(11071, 3040, 19723, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:51:25', '2021-03-11 16:51:25'),
(11072, 3040, 19723, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers ', NULL, NULL, '2021-03-19 16:14:50', '2021-03-19 16:14:50'),
(11073, 3046, 19724, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:51:38', '2021-03-11 16:51:38'),
(11074, 1006, 19724, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent an email query @ mmedina@ghn-mci.com & Susdeys@ghn-mci.com for enrollment status and how to proceed:   Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care LLC NPI# 1437481421  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If the above-mentioned providers are enrolled please send over their welcome letters and if they require enrollment please let me know what the process is.   Thank you.\"', NULL, NULL, '2021-04-20 13:11:15', '2021-04-20 13:11:15'),
(11075, 1006, 19724, NULL, '2021-04-30 00:00:00.000', 'In Process', 'Sent following email @ Karen Avalos kavalos@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello Karen,   Understood, does galaxy health enroll groups or does it only enroll individual providers? I only ask because I was unable to reach anyone on the given number.   Thanks. \"', NULL, NULL, '2021-04-23 12:54:10', '2021-04-23 12:54:10'),
(11076, 1006, 19724, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hi Brad,  Are you wanting a copy of the group contract Bay Area Quick care, that’s how the providers are contracted. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729  HIPAA Compliance Disclosure:  This email message and its attachments may contain confidential information that is legally privileged.  This information is intended only for the use of the intended recipient of this email message.  The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled unless otherwise required by state law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken with regard to the contents of these documents is strictly prohibited.  If you have received this email message in error, please notify the sender immediately to arrange for return of these documents.\"', NULL, NULL, '2021-04-27 08:36:16', '2021-04-27 08:36:16'),
(11077, 3040, 19724, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  Hi Brad,  Can you please send a letter from the facility requesting a copy of the contract. thanks', NULL, NULL, '2021-06-10 10:39:15', '2021-06-10 10:39:15'),
(11078, 11056, 19724, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent email to LeeAnn to send email to mmedina@ghn-mci.com for group contract. Letter is attached for reference.', NULL, NULL, '2021-06-21 13:21:00', '2021-06-21 13:21:00'),
(11079, 1006, 19724, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from kavalos@ghn-mci.com:  Sub: Fw:  \"Good morning;  Please send a letter signed by the person who sing the agreement.  Thank you if you have any questions please contact me directly. At 800-975-3322 ext 1601  Karen A   Karen Avalos Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 ext 1601 Fx: 817-633-5729\"  Asked LeeAnn to get the request signed by Cynthia and to forward it to me for further use. ', NULL, NULL, '2021-07-07 16:13:15', '2021-07-07 16:13:15'),
(11080, 1006, 19724, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Signed copy of the request received, sent following email @ Karen Avalos kavalos@ghn-mci.com:  Sub: RE: Group Contract Request - Bay Area Quick Care  \"Good morning Karen,   You requested a copy of this letter with the correct signature, please find it attached. Please send over the group contract as soon as you\'re able.   Thank you. \"', NULL, NULL, '2021-07-13 09:59:37', '2021-07-13 09:59:37'),
(11081, 1006, 19724, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Executed contract is attached for reference.   Eff: 01/26/2018', NULL, NULL, '2021-07-16 16:53:43', '2021-07-16 16:53:43'),
(11082, 3040, 19725, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:51:43', '2021-03-11 16:51:43'),
(11083, 3040, 19725, NULL, '2021-03-29 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual providers. ', NULL, NULL, '2021-03-22 09:51:15', '2021-03-22 09:51:15'),
(11084, 3040, 19726, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:52:04', '2021-03-11 16:52:04'),
(11085, 3040, 19726, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Talk with the Rep of Aetna Ron, He said our group has facility agreement so we don\'t load individual provider, provider will bill under the group Ref#5273841621', NULL, NULL, '2021-03-19 16:21:59', '2021-03-19 16:21:59'),
(11086, 3040, 19727, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:52:22', '2021-03-11 16:52:22'),
(11087, 3040, 19727, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-19 16:24:45', '2021-03-19 16:24:45'),
(11088, 3040, 19728, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:52:45', '2021-03-11 16:52:45'),
(11089, 3040, 19728, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider', NULL, NULL, '2021-03-19 16:27:40', '2021-03-19 16:27:40'),
(11090, 3046, 19729, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:53:02', '2021-03-11 16:53:02'),
(11091, 1006, 19729, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent an email query @ mmedina@ghn-mci.com & Susdeys@ghn-mci.com for enrollment status and how to proceed:   Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care LLC NPI# 1437481421  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If the above-mentioned providers are enrolled please send over their welcome letters and if they require enrollment please let me know what the process is.   Thank you.\"', NULL, NULL, '2021-04-20 13:11:30', '2021-04-20 13:11:30'),
(11092, 1006, 19729, NULL, '2021-04-30 00:00:00.000', 'Approved', 'Received the following approval confirmation from Susdey Sud Susdeys@ghn-mci.com:  \"Hello,  Cynthia Malowitz effective date is 01/26/18 and William Francis effective date is 08/31/20.  The attachment is application for you to complete for Melissa Ramsden and Kynda Orsak.  Should you have any questions, please do not hesitate to call us.  Sincerely,  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 887-3355  HIPAA Compliance Disclosure:  This email message and its attachments may contain confidential information that is legally privileged. This information is intended only for the use of the intended recipient of this email message. The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled unless otherwise required by state law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken with regard to the contents of these documents is strictly prohibited. If you have received this email message in error, please notify the sender immediately to arrange for return of these documents.\"  Regarding welcome letters and contracts:   \"Hello Brad;  This providers do not have a personal agreements. We don’t send copy of contract or welcome letter.  Please contact me at (800) 975-3322 ext 1601 if you have any questions.\"', NULL, NULL, '2021-04-23 12:48:12', '2021-04-23 12:48:12'),
(11093, 3040, 19730, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:53:48', '2021-03-11 16:53:48'),
(11094, 3040, 19730, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers. ', NULL, NULL, '2021-03-19 16:11:17', '2021-03-19 16:11:17'),
(11095, 3040, 19731, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:54:09', '2021-03-11 16:54:09'),
(11096, 3040, 19731, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract No need to add individual providers ', NULL, NULL, '2021-03-19 16:14:48', '2021-03-19 16:14:48'),
(11097, 3046, 19732, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:54:26', '2021-03-11 16:54:26');
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
(11098, 1006, 19732, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Sent an email query @ mmedina@ghn-mci.com & Susdeys@ghn-mci.com for enrollment status and how to proceed:   Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,   I hope you\'re doing well, I wanted to verify the enrollment status for the following group and providers:   Group Name: Bay Area Quick Care LLC NPI# 1437481421  Provider Name: Cynthia Malowitz NPI# 1336173244  Provider Name: Kynda Orsak NPI# 1528553724  Provider Name: William Francis NPI# 1457994436  Provider Name: Melissa Ramsden NPI# 1194376228  If the above-mentioned providers are enrolled please send over their welcome letters and if they require enrollment please let me know what the process is.   Thank you.\"', NULL, NULL, '2021-04-20 13:11:34', '2021-04-20 13:11:34'),
(11099, 1006, 19732, NULL, '2021-04-30 00:00:00.000', 'In Process', 'We received the following reply from Susdey Sud Susdeys@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hello,  Cynthia Malowitz effective date is 01/26/18 and William Francis effective date is 08/31/20.  The attachment is application for you to complete for Melissa Ramsden and Kynda Orsak. Should you have any questions, please do not hesitate to call us.  Sincerely,  Susdey Sud Director, Network Operations Office Phone: (800) 975-3322 Office Fax: (817) 887-3355\" ', NULL, NULL, '2021-04-23 09:48:29', '2021-04-23 09:48:29'),
(11100, 1006, 19732, NULL, '2021-04-30 00:00:00.000', 'In Process', 'The form was filled out and faxed to (817) 633-5729. Attached for reference.', NULL, NULL, '2021-04-23 12:00:27', '2021-04-23 12:00:27'),
(11101, 1006, 19732, NULL, '2021-05-04 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  \"Hi Brad,  Are you wanting a copy of the group contract Bay Area Quick care, that’s how the providers are contracted. Thanks  Malanie Medina Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 Fx: 817-633-5729  HIPAA Compliance Disclosure:  This email message and its attachments may contain confidential information that is legally privileged.  This information is intended only for the use of the intended recipient of this email message.  The authorized recipient of this information is prohibited from disclosing this information to any other party and is required to destroy the information after its stated need has been fulfilled unless otherwise required by state law. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution, or action taken with regard to the contents of these documents is strictly prohibited.  If you have received this email message in error, please notify the sender immediately to arrange for return of these documents.\"', NULL, NULL, '2021-04-27 08:36:23', '2021-04-27 08:36:23'),
(11102, 3040, 19732, NULL, '2021-06-17 00:00:00.000', 'In Process', 'Received the following reply from Malanie Medina mmedina@ghn-mci.com:  Sub: Enrollment Query - Bay Area Quick Care - Galaxy Health  Hi Brad,  Can you please send a letter from the facility requesting a copy of the contract. thanks', NULL, NULL, '2021-06-10 10:39:07', '2021-06-10 10:39:07'),
(11103, 11056, 19732, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Sent email to LeeAnn to send email to mmedina@ghn-mci.com for group contract. Letter is attached for reference.', NULL, NULL, '2021-06-21 13:22:18', '2021-06-21 13:22:18'),
(11104, 1006, 19732, NULL, '2021-07-14 00:00:00.000', 'In Process', 'We received the following reply from kavalos@ghn-mci.com:  Sub: Fw:  \"Good morning;  Please send a letter signed by the person who sing the agreement.  Thank you if you have any questions please contact me directly. At 800-975-3322 ext 1601  Karen A   Karen Avalos Network Support Coordinator Galaxy Health Network Ph: 817-633-5822 or 800-975-3322 ext 1601 Fx: 817-633-5729\"  Asked LeeAnn to get the request signed by Cynthia and to forward it to me for further use. ', NULL, NULL, '2021-07-07 16:13:20', '2021-07-07 16:13:20'),
(11105, 1006, 19732, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Signed copy of the request received, sent following email @ Karen Avalos kavalos@ghn-mci.com:  Sub: RE: Group Contract Request - Bay Area Quick Care  \"Good morning Karen,   You requested a copy of this letter with the correct signature, please find it attached. Please send over the group contract as soon as you\'re able.   Thank you. \"', NULL, NULL, '2021-07-13 09:59:41', '2021-07-13 09:59:41'),
(11106, 1006, 19732, NULL, '2021-07-23 00:00:00.000', 'Approved', 'Executed contract is attached for reference.   Eff: 01/26/2018', NULL, NULL, '2021-07-16 16:53:55', '2021-07-16 16:53:55'),
(11107, 3040, 19733, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:54:36', '2021-03-11 16:54:36'),
(11108, 3040, 19733, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Talk with the Rep of Aetna Ron, He said our group has facility agreement so we don\'t load individual provider, provider will bill under the group Ref#5273841621', NULL, NULL, '2021-03-19 16:21:41', '2021-03-19 16:21:41'),
(11109, 3040, 19734, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:54:59', '2021-03-11 16:54:59'),
(11110, 3040, 19734, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-19 16:24:50', '2021-03-19 16:24:50'),
(11111, 3040, 19735, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:55:20', '2021-03-11 16:55:20'),
(11112, 3040, 19735, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider', NULL, NULL, '2021-03-19 16:27:46', '2021-03-19 16:27:46'),
(11113, 3046, 19736, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:55:47', '2021-03-11 16:55:47'),
(11114, 9057, 19736, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to  pr.south@healthsmart.com Request for enrollment status - BAQC - Health Smart  Hello, we submitted enrollment forms for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:08:03', '2021-05-31 13:08:03'),
(11115, 1006, 19736, NULL, '2021-06-24 00:00:00.000', 'In Process', 'We received the following reply from pr.south@healthsmart.com:  Sub: Request for enrollment status - BAQC - Health Smart  \"02- Please fill out the attached CAQH Access form and send W9 so that we can process this update.  Provider Name    Malowitz, Cynthia   All communication, including requested documents, should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com\"  The form has been filled out and sent, it is attached for reference. ', NULL, NULL, '2021-06-17 17:10:41', '2021-06-17 17:10:41'),
(11116, 1006, 19736, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from Provider Relations - South pr.south@healthsmart.com:  Sub: Request for enrollment status - BAQC - Health Smart  \"Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  Malowitz, Cynthia K NP  All communication, including requested documents, should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID: 82042 )  Thanks HealthSmart Provider Relations.\"', NULL, NULL, '2021-06-21 08:49:06', '2021-06-21 08:49:06'),
(11117, 1006, 19736, NULL, '2021-06-29 00:00:00.000', 'In Process', 'We received the following reply Cesar.Guilarducci@healthsmart.com:   Sub: Credentialing  \"Re: 1336173244  Re: Cynthia Kay Malowitz, NP   Good Afternoon  I am credentialing Cynthia Malowitz. I will need a copy of her nurses board cert from the AANP. Can you please send me a copy,  Please advise  Regards,  Cesar Guilarducci |  Credentialing Specialist HealthSmart | Network Solutions Office  214.574.2669  Fax: 214.574.2368 222 W Las Colinas Blvd, Suite 500 Irving, Texas 75039 Cesar.Guilarducci@healthsmart.com | www.HealthSmart.com\"  Replied: \"Hello Cesar,  Please find the attached copy of Cynthia\'s AANP certification, do let me know if anything else is required. Thank you!\"', NULL, NULL, '2021-06-22 15:11:10', '2021-06-22 15:11:10'),
(11118, 1006, 19736, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ Cesar Guilarducci Cesar.Guilarducci@healthsmart.com & Credentialing Applications Credentialing.Applications@healthsmart.com:  Sub: Credentialing  \"Hello Cesar,   I wanted to check in with you regarding the enrollment status for Cynthia Malowitz, can you please get back to me ASAP?  Thank you.\"', NULL, NULL, '2021-07-08 13:12:26', '2021-07-08 13:12:26'),
(11119, 1006, 19736, NULL, '2021-07-30 00:00:00.000', 'Approved', '\"Hi Brad,  Completed and effective date 08/01/2021  Cesar Guilarducci |  Credentialing Specialist HealthSmart | Network Solutions Office  214.574.2669  Fax: 214.574.2368 222 W Las Colinas Blvd, Suite 500 Irving, Texas 75039 Cesar.Guilarducci@healthsmart.com | www.HealthSmart.com\"', NULL, NULL, '2021-07-23 15:44:48', '2021-07-23 15:44:48'),
(11120, 3046, 19737, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:56:51', '2021-03-11 16:56:51'),
(11121, 9057, 19737, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to  pr.south@healthsmart.com Request for enrollment status - BAQC - Health Smart  Hello, we submitted enrollment forms for the below mentioned provider under the following group.   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:08:16', '2021-05-31 13:08:16'),
(11122, 1006, 19737, NULL, '2021-06-24 00:00:00.000', 'Approved', 'The provider is approved with Healthsmart, received the following email from pr.south@healthsmart.com:  Sub: Request for enrollment status - BAQC - Health Smart  \"Hi,  01- Please see the following Providers with effective dates.  Provider Name            Effective Date   Kynda K Orsak, NP        07/01/2019\"  ', NULL, NULL, '2021-06-17 15:53:43', '2021-06-17 15:53:43'),
(11123, 3046, 19738, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:57:41', '2021-03-11 16:57:41'),
(11124, 9057, 19738, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:09:56', '2021-05-31 13:09:56'),
(11125, 9057, 19738, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:10:19', '2021-05-31 13:10:19'),
(11126, 1006, 19738, NULL, '2021-06-24 00:00:00.000', 'Approved', 'As per my discussion with Humana, the group is approved as of Eff: 08/25/2010  Ref# 2000188531709', NULL, NULL, '2021-06-17 16:38:47', '2021-06-17 16:38:47'),
(11127, 3046, 19739, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:58:42', '2021-03-11 16:58:42'),
(11128, 9057, 19739, NULL, '2021-06-07 00:00:00.000', 'In Process', 'We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you', NULL, NULL, '2021-05-31 13:09:42', '2021-05-31 13:09:42'),
(11129, 1006, 19739, NULL, '2021-06-24 00:00:00.000', 'Approved', 'As per my discussion with Humana, the provider is approved as of Eff: 08/25/2010  Ref# 2000188531709', NULL, NULL, '2021-06-17 16:38:27', '2021-06-17 16:38:27'),
(11130, 3040, 19740, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:58:47', '2021-03-11 16:58:47'),
(11131, 3040, 19740, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider ', NULL, NULL, '2021-03-19 16:37:29', '2021-03-19 16:37:29'),
(11132, 3040, 19740, NULL, '2021-07-09 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-07-02 13:42:13', '2021-07-02 13:42:13'),
(11133, 3040, 19740, NULL, '2021-07-09 00:00:00.000', 'Revalidated', 'Email rcvd from: ACS Re-credentialing Approval Letter - Valley Med Urgent Care PLLC  Subject: Jennifer.Maligaya@healthsmart.com  Hello,  Please see the attached ACS Re-credentialing Approval Letter. Thank you for your continued participation.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-02 13:43:44', '2021-07-02 13:43:44'),
(11134, 3040, 19741, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:58:48', '2021-03-11 16:58:48'),
(11135, 3040, 19741, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider ', NULL, NULL, '2021-03-19 16:37:37', '2021-03-19 16:37:37'),
(11136, 3040, 19741, NULL, '2021-07-09 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-07-02 13:42:11', '2021-07-02 13:42:11'),
(11137, 3040, 19741, NULL, '2021-07-09 00:00:00.000', 'Revalidated', 'Email rcvd from: ACS Re-credentialing Approval Letter - Valley Med Urgent Care PLLC  Subject: Jennifer.Maligaya@healthsmart.com  Hello,  Please see the attached ACS Re-credentialing Approval Letter. Thank you for your continued participation.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-02 13:43:40', '2021-07-02 13:43:40'),
(11138, 3040, 19742, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:58:49', '2021-03-11 16:58:49'),
(11139, 3040, 19742, NULL, '2021-03-26 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider ', NULL, NULL, '2021-03-19 16:37:43', '2021-03-19 16:37:43'),
(11140, 3040, 19742, NULL, '2021-07-09 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-07-02 13:42:08', '2021-07-02 13:42:08'),
(11141, 3040, 19742, NULL, '2021-07-09 00:00:00.000', 'Revalidation', '', NULL, NULL, '2021-07-02 13:42:32', '2021-07-02 13:42:32'),
(11142, 3040, 19742, NULL, '2021-07-09 00:00:00.000', 'Revalidated', 'Email rcvd from: ACS Re-credentialing Approval Letter - Valley Med Urgent Care PLLC  Subject: Jennifer.Maligaya@healthsmart.com  Hello,  Please see the attached ACS Re-credentialing Approval Letter. Thank you for your continued participation.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-02 13:43:35', '2021-07-02 13:43:35'),
(11143, 3046, 19743, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:59:10', '2021-03-11 16:59:10'),
(11144, 1006, 19743, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Sent f/u email @ stxnm@humana.com:  Sub: Request for enrollment status  - BAQC - Humana  \"We sent an email to stxnm@humana.com Sub: Request for enrollment status  - BAQC - Humana  Hello, We asked to link the following credentialed providers under the following group, the information is as follows:   Group Name: Bay Area Quick Care LLC NPI: 1437481421 TIN# 27-1702009 Main Address: 9929 South Padre Island Drive, Suite 109, Corpus Christi, TX 78418  Provider name: Orsak, Kynda  NPI# 1528553724  Provider Name: Malowitz, Cynthia NPI# 1336173244  Provider Name: Ramsden, Melissa NPI# 1194376228   Kindly update me with the current status regarding the above mentioned request.as soon as possible.  Thank you\"', NULL, NULL, '2021-06-07 08:58:45', '2021-06-07 08:58:45'),
(11145, 1006, 19743, NULL, '2021-06-24 00:00:00.000', 'Approved', 'As per my discussion with Humana, the provider is approved as of Eff: 06/01/2018  Ref# 2000188531709', NULL, NULL, '2021-06-17 16:38:05', '2021-06-17 16:38:05'),
(11146, 3040, 19744, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:59:32', '2021-03-11 16:59:32'),
(11147, 3040, 19744, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-24 08:59:58', '2021-03-24 08:59:58'),
(11148, 3040, 19744, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:05', '2021-04-14 07:24:05'),
(11149, 3040, 19744, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:00', '2021-06-01 15:03:00'),
(11150, 3040, 19744, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:18', '2021-06-02 16:50:18'),
(11151, 3040, 19745, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:59:33', '2021-03-11 16:59:33'),
(11152, 3040, 19745, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider ', NULL, NULL, '2021-03-24 09:01:37', '2021-03-24 09:01:37'),
(11153, 3040, 19746, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 16:59:34', '2021-03-11 16:59:34'),
(11154, 3040, 19746, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-24 08:59:57', '2021-03-24 08:59:57'),
(11155, 3040, 19746, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:10', '2021-04-14 07:24:10'),
(11156, 3040, 19746, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:01:53', '2021-06-01 15:01:53'),
(11157, 3040, 19746, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:27', '2021-06-02 16:47:27'),
(11158, 3046, 19747, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:03', '2021-03-11 17:00:03'),
(11159, 1006, 19747, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group is contracted with MCO and listed as an Urgent Care Facility. Effective 09/16/2020. Provider ID#1304027. Executed contract is attached on group task for reference. ', NULL, NULL, '2021-05-04 10:39:55', '2021-05-04 10:39:55'),
(11160, 3040, 19748, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:33', '2021-03-11 17:00:33'),
(11161, 3040, 19748, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Emails sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-24 09:06:40', '2021-03-24 09:06:40'),
(11162, 3040, 19748, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:25:31', '2021-04-14 07:25:31'),
(11163, 3040, 19748, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:06', '2021-06-01 15:03:06'),
(11164, 3040, 19748, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:23', '2021-06-02 16:50:23'),
(11165, 3040, 19749, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:34', '2021-03-11 17:00:34'),
(11166, 3040, 19749, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary Contract. No need to add individual provider.', NULL, NULL, '2021-03-24 09:05:38', '2021-03-24 09:05:38'),
(11167, 3040, 19750, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:35', '2021-03-11 17:00:35'),
(11168, 3040, 19750, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Please find the attached LOI to enroll the below mentioned providers in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider Name: Lopez, Mayra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 16:41:21', '2021-06-01 16:41:21'),
(11169, 3040, 19750, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 3: Provider Name: Lopez, Mayra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 14:33:37', '2021-06-21 14:33:37'),
(11170, 3040, 19750, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com,  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Has there been any update?   Thank you  ', NULL, NULL, '2021-07-12 10:57:36', '2021-07-12 10:57:36'),
(11171, 12062, 19750, NULL, '2021-10-02 00:00:00.000', 'Approved', 'As per the conversation with tele representative , the provider is enrolled with the effective date 12/24/2018.the call reference is 7808-JACKIE S.  See attached screenshot for your reference.', NULL, NULL, '2021-09-24 16:24:37', '2021-09-24 16:24:37'),
(11172, 3046, 19751, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:43', '2021-03-11 17:00:43'),
(11173, 1006, 19751, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group is contracted with MCO and listed as an Urgent Care Facility. Effective 09/16/2020. Provider ID#1304027. Executed contract is attached on group task for reference. ', NULL, NULL, '2021-05-04 10:40:05', '2021-05-04 10:40:05'),
(11174, 3046, 19752, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:00:52', '2021-03-11 17:00:52'),
(11175, 1006, 19752, NULL, '2021-05-11 00:00:00.000', 'Approved', 'The group is contracted with MCO and listed as an Urgent Care Facility. Effective 09/16/2020. Provider ID#1304027. Executed contract is attached on group task for reference. ', NULL, NULL, '2021-05-04 10:40:07', '2021-05-04 10:40:07'),
(11176, 3040, 19753, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:12', '2021-03-11 17:01:12'),
(11177, 3040, 19753, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Please find the attached LOI to enroll the below mentioned providers in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider Name: Lopez, Mayra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 16:41:27', '2021-06-01 16:41:27'),
(11178, 3040, 19753, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 3: Provider Name: Lopez, Mayra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 14:33:31', '2021-06-21 14:33:31'),
(11179, 3040, 19753, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com,  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Has there been any update?   Thank you  ', NULL, NULL, '2021-07-12 10:57:32', '2021-07-12 10:57:32'),
(11180, 12062, 19753, NULL, '2021-10-02 00:00:00.000', 'Approved', 'As per the conversation with tele representative , the provider is enrolled with the effective date 08/29/2019.the call reference is 7808-JACKIE S.  See attached screenshot for your reference.', NULL, NULL, '2021-09-24 16:24:00', '2021-09-24 16:24:00'),
(11181, 3040, 19754, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:12', '2021-03-11 17:01:12'),
(11182, 3040, 19754, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Please find the attached LOI to enroll the below mentioned providers in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider Name: Lopez, Mayra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 16:41:35', '2021-06-01 16:41:35'),
(11183, 3040, 19754, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 3: Provider Name: Lopez, Mayra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 14:33:26', '2021-06-21 14:33:26'),
(11184, 3040, 19754, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com,  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Has there been any update?   Thank you  ', NULL, NULL, '2021-07-12 10:57:30', '2021-07-12 10:57:30'),
(11185, 12062, 19754, NULL, '2021-10-02 00:00:00.000', 'Approved', 'As per the conversation with tele representative , the provider is enrolled with the effective date 08/27/2017.the call reference is 7808-JACKIE S.  See attached screenshot for your reference.', NULL, NULL, '2021-09-24 16:22:51', '2021-09-24 16:22:51'),
(11186, 3040, 19755, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:13', '2021-03-11 17:01:13'),
(11187, 3040, 19755, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-03-24 09:15:09', '2021-03-24 09:15:09'),
(11188, 3040, 19755, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:25:15', '2021-04-14 07:25:15'),
(11189, 3040, 19755, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:01:58', '2021-06-01 15:01:58'),
(11190, 3040, 19755, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:31', '2021-06-02 16:47:31'),
(11191, 3040, 19756, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:57', '2021-03-11 17:01:57'),
(11192, 3040, 19756, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:17:47', '2021-03-24 09:17:47'),
(11193, 3040, 19756, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:26:19', '2021-04-14 07:26:19'),
(11194, 3040, 19756, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:09', '2021-06-01 15:03:09'),
(11195, 3040, 19756, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:26', '2021-06-02 16:50:26'),
(11196, 3040, 19757, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:58', '2021-03-11 17:01:58'),
(11197, 3040, 19757, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com  Subject: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Please find the attached LOI to enroll the below mentioned providers in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider Name: Lopez, Mayra Provider NPI# 1265945125  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 16:41:11', '2021-06-01 16:41:11'),
(11198, 3040, 19757, NULL, '2021-06-28 00:00:00.000', 'In Process', 'Hello,   Hope you are doing well. I wanted to enroll the below mentioned provider in UHC Plan (Texas Star Kids) in our group Valley Med Urgent Care PLLC under the below locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166      Provider 1: Provider Name: Hernandez, Eder Provider NPI# 1386956852  Provider 2: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 3: Provider Name: Lopez, Mayra Provider NPI# 1265945125  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-21 14:33:22', '2021-06-21 14:33:22'),
(11199, 3040, 19757, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: jason_trieu@uhc.com,  Subject: Re: Enroll Providers || Valley Med Urgent Care PLLC || Hernandez, Eder, Lopez, Mayra & Garcia, Homero || UHC Plan (Texas Star Kids) ||  Greetings,   Has there been any update?   Thank you  ', NULL, NULL, '2021-07-12 10:57:28', '2021-07-12 10:57:28'),
(11200, 12062, 19757, NULL, '2021-10-02 00:00:00.000', 'Approved', 'As per the conversation with tele representative , the provider is enrolled with the effective date 09/01/2019.the call reference is 7808-JACKIE S.  See attached screenshot for your reference.', NULL, NULL, '2021-09-24 16:21:22', '2021-09-24 16:21:22'),
(11201, 3040, 19758, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:01:58', '2021-03-11 17:01:58'),
(11202, 3040, 19758, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:17:55', '2021-03-24 09:17:55'),
(11203, 3040, 19758, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:26:23', '2021-04-14 07:26:23'),
(11204, 3040, 19758, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:02', '2021-06-01 15:02:02'),
(11205, 3040, 19758, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:34', '2021-06-02 16:47:34'),
(11206, 3046, 19759, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:02:40', '2021-03-11 17:02:40'),
(11207, 9057, 19759, NULL, '2021-06-08 00:00:00.000', 'Approved', 'This Provider has already been approved  Effective Date 04/01/2010 TPI No.198537603', NULL, NULL, '2021-05-31 15:00:33', '2021-05-31 15:00:33'),
(11208, 1006, 19759, NULL, '2021-09-09 00:00:00.000', 'Revalidation', 'Requested disenrollment from Medicaid with 09/01/2021 effective date. ', NULL, NULL, '2021-09-02 10:26:15', '2021-09-02 10:26:15'),
(11209, 11056, 19759, NULL, '2021-10-04 00:00:00.000', 'Revalidation', 'Disenrolled  Portal Ticket #	Application Name	NPI	Status Update Date	Transction Type	Status	 18058756	PIMS Enrollment Informati		9/15/2021	Provider Information Change (PIC) Form	Closed', NULL, NULL, '2021-09-27 16:00:50', '2021-09-27 16:00:50'),
(11210, 11056, 19759, NULL, '2021-12-08 00:00:00.000', 'Revalidated', 'Disenrolled  Portal Ticket #Ascending	Application Name	NPI	Status Update Date	Transction Type	Status   15122518	Cynthia Malowitz	1336173244	6/22/2018	Enrollment - First Time Applicant	Closed', NULL, NULL, '2021-12-01 12:23:35', '2021-12-01 12:23:35'),
(11211, 3040, 19760, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:02:43', '2021-03-11 17:02:43'),
(11212, 3040, 19760, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:18:58', '2021-03-24 09:18:58'),
(11213, 3040, 19760, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:52', '2021-04-14 07:24:52'),
(11214, 3040, 19760, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:12', '2021-06-01 15:03:12');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(11215, 3040, 19760, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:29', '2021-06-02 16:50:29'),
(11216, 3040, 19761, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:02:44', '2021-03-11 17:02:44'),
(11217, 3040, 19761, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:18:49', '2021-03-24 09:18:49'),
(11218, 3040, 19762, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:02:45', '2021-03-11 17:02:45'),
(11219, 3040, 19762, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:19:02', '2021-03-24 09:19:02'),
(11220, 3040, 19762, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:56', '2021-04-14 07:24:56'),
(11221, 3040, 19762, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:05', '2021-06-01 15:02:05'),
(11222, 3040, 19762, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:38', '2021-06-02 16:47:38'),
(11223, 3040, 19763, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:03:22', '2021-03-11 17:03:22'),
(11224, 3040, 19763, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:20:26', '2021-03-24 09:20:26'),
(11225, 3040, 19763, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:32', '2021-04-14 07:24:32'),
(11226, 3040, 19763, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:20', '2021-06-01 15:03:20'),
(11227, 3040, 19763, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:32', '2021-06-02 16:50:32'),
(11228, 3040, 19764, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:03:23', '2021-03-11 17:03:23'),
(11229, 3040, 19764, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:19:40', '2021-03-24 09:19:40'),
(11230, 3040, 19765, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:03:24', '2021-03-11 17:03:24'),
(11231, 3040, 19765, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:20:32', '2021-03-24 09:20:32'),
(11232, 3040, 19765, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:24:37', '2021-04-14 07:24:37'),
(11233, 3040, 19765, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:08', '2021-06-01 15:02:08'),
(11234, 3040, 19765, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:45', '2021-06-02 16:47:45'),
(11235, 3046, 19766, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:03:25', '2021-03-11 17:03:25'),
(11236, 9057, 19766, NULL, '2021-06-07 00:00:00.000', 'Approved', 'The Provider is already effective  Effective Date: 04/01/2010 Medicare ID   : TXB101018  Proof Attached.', NULL, NULL, '2021-05-31 13:44:06', '2021-05-31 13:44:06'),
(11237, 1006, 19767, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:03:27', '2021-03-11 17:03:27'),
(11238, 1006, 19767, NULL, '2021-04-27 00:00:00.000', 'Initiated', 'Submitted request to enroll provider via Aetna\'s online portal. Attached enrollment request for reference. ', NULL, NULL, '2021-04-20 14:15:29', '2021-04-20 14:15:29'),
(11239, 1019, 19767, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:45:49', '2021-05-03 10:45:49'),
(11240, 1019, 19767, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Sent the following email to Laura.Bevin@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello, We need the enrollment application status for the following providers,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Mary Gibbons NPI: 1942388483 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Jessica Hartman NPI: 1326665472 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Regards,', NULL, NULL, '2021-05-20 08:03:33', '2021-05-20 08:03:33'),
(11241, 1019, 19767, NULL, '2021-05-31 00:00:00.000', 'Approved', 'Received the following email from reply-fec811777167077c-92_HTML-214289560-515007887-195@provider.aetna.com  Hi Erin Oliva,  Welcome to the provider network effective May 14 2021 12:00AM.  Your Provider Identification Number (PIN) is: 4841425.', NULL, NULL, '2021-05-24 08:39:25', '2021-05-24 08:39:25'),
(11242, 3040, 19768, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:01', '2021-03-11 17:04:01'),
(11243, 3040, 19768, NULL, '2021-03-31 00:00:00.000', 'Initiated', ' Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:21:33', '2021-03-24 09:21:33'),
(11244, 3040, 19768, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:27:01', '2021-04-14 07:27:01'),
(11245, 3040, 19768, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:24', '2021-06-01 15:03:24'),
(11246, 3040, 19768, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:35', '2021-06-02 16:50:35'),
(11247, 3040, 19769, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:01', '2021-03-11 17:04:01'),
(11248, 3040, 19769, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:21:18', '2021-03-24 09:21:18'),
(11249, 3040, 19770, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:02', '2021-03-11 17:04:02'),
(11250, 3040, 19770, NULL, '2021-03-31 00:00:00.000', 'Initiated', ' Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-03-24 09:21:38', '2021-03-24 09:21:38'),
(11251, 3040, 19770, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:27:05', '2021-04-14 07:27:05'),
(11252, 3040, 19770, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:13', '2021-06-01 15:02:13'),
(11253, 3040, 19770, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:47', '2021-06-02 16:47:47'),
(11254, 3046, 19771, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:03', '2021-03-11 17:04:03'),
(11255, 9057, 19771, NULL, '2021-06-07 00:00:00.000', 'Approved', 'The Provider is already effective  Effective Date: 04/01/2010 Medicare ID   : TXB101018  Proof Attached.', NULL, NULL, '2021-05-31 13:45:02', '2021-05-31 13:45:02'),
(11256, 1006, 19772, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:14', '2021-03-11 17:04:14'),
(11257, 1019, 19772, NULL, '2021-04-02 00:00:00.000', 'Initiated', 'Your request to join the network has been received. You can expect to hear from us in the next 45 days. If it has been more than 60 days and you haven’t heard from us regarding next steps, you can call 1-800-353-1232 for assistance. Please reference code “BH\".', NULL, NULL, '2021-03-19 13:02:20', '2021-03-19 13:02:20'),
(11258, 1019, 19772, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to Laura :Laura.Bevin@aetna.com  Sub: Enrollment Status || Providers || SNBCARE || Aetna Hello Laura, Hope you\'re doing well, can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Barbara HIgnite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-04-08 10:18:03', '2021-04-08 10:18:03'),
(11259, 1019, 19772, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Received the following the email from Laura.Bevin@aetna.com Good afternoon,  Barbara HIgnite, 6369000 – waiting to be linked    Kerry Smith, 6164300 – CAQH application is being reviewed by our Credentialing Dept.  Rodesia Edmundson – very early in the credentialing process, application was received on 04/05/2021  Justin Souliere, 6893422 - CAQH application is being reviewed by our Credentialing Dept.     Thank you', NULL, NULL, '2021-04-08 11:31:24', '2021-04-08 11:31:24'),
(11260, 3040, 19772, NULL, '2021-04-23 00:00:00.000', 'In Process', 'I had a word with Aetna representative and he said the application was received on 03/19/2021 and still in credentialing process.   It will take up to 60 Business days. ', NULL, NULL, '2021-04-16 16:11:25', '2021-04-16 16:11:25'),
(11261, 1019, 19772, NULL, '2021-05-10 00:00:00.000', 'In Process', 'Sent the following email to : Laura.Bevin@aetna.com, ChandraKumarU@aetna.com SUB: Enrollment Query || Group & Providers || SNBCARE || Aetna  Hello,   Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Individual Provider:  Melody L\'Etoile 1942687108 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Rodesia Edmundson 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Prisca Hefti 1508133182 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Barbara Hignite 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Fauzia Wali Khan 1699761965 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Lynnetta Loveland 1598163602 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Peggy Pionke 1699307322 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Mahreen Rashid 1396393146 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Carlee Rozell 1225645393 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jonathan Schubert 1235755505 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Kerry Smith 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702. Secondary Location: 100 New State Highway, Raynham, MA, 02767.    Katie Tawakol 1609222116 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Jennifer Ullrich 1710489760 Secondary Location: 100 New State Highway, Raynham, MA, 02767.      Justin Souliere 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.  Erin Oliva 1407349632 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-05-03 10:45:29', '2021-05-03 10:45:29'),
(11262, 1019, 19772, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Received the following email from reply-fec811777167077c-92_HTML-214289560-515007887-185@provider.aetna.com SUB: Welcome to our network. Let’s get started.  Hi Justin Souliere,  Welcome to the provider network effective May 7 2021 12:00AM.  Your Provider Identification Number (PIN) is: 6893422.  Ready to get started? To help make your onboarding easy, just check out the attached welcome kit.    Register here to attend our new provider onboarding webinar - Doing business with Aetna® . Sessions are held on the second Tuesday and third Wednesday of each month from 1:00 p.m. – 2:15 p.m. ET. You\'ll discover additional online tools and resources to make your day-to-day Aetna tasks quick and simple.     Laptop If you want more information, visit our provider welcome page.  Learn more     Aetna logo     Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna).  This message is for informational purposes only, is not medical advice and is not intended to be a substitute for proper medical care provided by a physician. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna® plans, refer to Aetna.com.  Help/contact us: If you have any questions, please contact us.  You are receiving this because you have elected to communicate with Aetna through email. If you no longer wish to receive these particular messages via email, you may unsubscribe at any time.  We are located at 151 Farmington Avenue, Hartford, CT 06156.  Privacy Statement | Terms of Use | Privacy Information | Member Disclosure  ©2021 Aetna Inc. 23.36.898.1 (01/21)', NULL, NULL, '2021-05-18 09:34:54', '2021-05-18 09:34:54'),
(11263, 1006, 19773, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:31', '2021-03-11 17:04:31'),
(11264, 1006, 19773, NULL, '2021-04-16 00:00:00.000', 'On Hold', 'The enrollment request is pending on the provider\'s RI PMHNP license to be issued. ', NULL, NULL, '2021-04-09 14:57:29', '2021-04-09 14:57:29'),
(11265, 1019, 19773, NULL, '2021-10-14 00:00:00.000', 'Not Eligible', 'Provider will no longer continue with SNBCARE.', NULL, NULL, '2021-10-06 23:49:07', '2021-10-06 23:49:07'),
(11266, 3040, 19774, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:44', '2021-03-11 17:04:44'),
(11267, 3040, 19774, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:22:44', '2021-03-24 09:22:44'),
(11268, 3040, 19774, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:27:25', '2021-04-14 07:27:25'),
(11269, 3040, 19774, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:27', '2021-06-01 15:03:27'),
(11270, 3040, 19774, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:42', '2021-06-02 16:50:42'),
(11271, 3040, 19775, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:45', '2021-03-11 17:04:45'),
(11272, 3040, 19775, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:22:30', '2021-03-24 09:22:30'),
(11273, 3040, 19776, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:04:46', '2021-03-11 17:04:46'),
(11274, 3040, 19776, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:22:49', '2021-03-24 09:22:49'),
(11275, 3040, 19776, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:27:29', '2021-04-14 07:27:29'),
(11276, 3040, 19776, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:22', '2021-06-01 15:02:22'),
(11277, 3040, 19776, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:50', '2021-06-02 16:47:50'),
(11278, 3046, 19777, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:07', '2021-03-11 17:05:07'),
(11279, 9057, 19777, NULL, '2021-06-08 00:00:00.000', 'Approved', 'This group is already been Approved   Effective Date : 04/01/2010 PTAN No. DV9128   Proof Attached', NULL, NULL, '2021-05-31 14:20:38', '2021-05-31 14:20:38'),
(11280, 3040, 19778, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:22', '2021-03-11 17:05:22'),
(11281, 3040, 19778, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:23:21', '2021-03-24 09:23:21'),
(11282, 1005, 19778, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:34:37', '2021-06-01 14:34:37'),
(11283, 3040, 19778, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:44', '2021-06-02 16:50:44'),
(11284, 3040, 19779, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:23', '2021-03-11 17:05:23'),
(11285, 3040, 19779, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:23:10', '2021-03-24 09:23:10'),
(11286, 3040, 19780, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:23', '2021-03-11 17:05:23'),
(11287, 3040, 19780, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:23:25', '2021-03-24 09:23:25'),
(11288, 1005, 19780, NULL, '2021-06-09 00:00:00.000', 'Not Eligible', 'The provider Moses Campos is no longer with Valley Med Urgent Care', NULL, NULL, '2021-06-01 14:34:55', '2021-06-01 14:34:55'),
(11289, 3040, 19780, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:52', '2021-06-02 16:47:52'),
(11290, 1006, 19781, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:41', '2021-03-11 17:05:41'),
(11291, 1019, 19781, NULL, '2021-04-26 00:00:00.000', 'Approved', 'Effective date is 06/01/2020. Attached is the proof for In network', NULL, NULL, '2021-04-19 13:10:30', '2021-04-19 13:10:30'),
(11292, 3046, 19782, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:59', '2021-03-11 17:05:59'),
(11293, 9057, 19782, NULL, '2021-06-08 00:00:00.000', 'Approved', 'This Provider  is already been approved Effective Date: 04/01/2010 PTAN# 	P01515945  Proof is attached', NULL, NULL, '2021-05-31 14:25:57', '2021-05-31 14:25:57'),
(11294, 3040, 19783, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:05:59', '2021-03-11 17:05:59'),
(11295, 3040, 19783, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:24:12', '2021-03-24 09:24:12'),
(11296, 3040, 19783, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:26:38', '2021-04-14 07:26:38'),
(11297, 3040, 19783, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:31', '2021-06-01 15:03:31'),
(11298, 3040, 19783, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:48', '2021-06-02 16:50:48'),
(11299, 3040, 19784, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:00', '2021-03-11 17:06:00'),
(11300, 3040, 19784, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:23:58', '2021-03-24 09:23:58'),
(11301, 3040, 19785, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:01', '2021-03-11 17:06:01'),
(11302, 3040, 19785, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:24:16', '2021-03-24 09:24:16'),
(11303, 3040, 19785, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:26:42', '2021-04-14 07:26:42'),
(11304, 3040, 19785, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:35', '2021-06-01 15:02:35'),
(11305, 3040, 19785, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:47:59', '2021-06-02 16:47:59'),
(11306, 3046, 19786, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:10', '2021-03-11 17:06:10'),
(11307, 9057, 19786, NULL, '2021-06-08 00:00:00.000', 'Approved', 'This provider has already been enrolled Effective Date: 06/26/2018 PTAN # 	P02112205  Proof is attached', NULL, NULL, '2021-05-31 14:36:42', '2021-05-31 14:36:42'),
(11308, 3040, 19787, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:38', '2021-03-11 17:06:38'),
(11309, 3040, 19787, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:24:50', '2021-03-24 09:24:50'),
(11310, 3040, 19787, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:25:57', '2021-04-14 07:25:57'),
(11311, 3040, 19787, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:03:35', '2021-06-01 15:03:35'),
(11312, 3040, 19787, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract.  ', NULL, NULL, '2021-06-02 16:50:52', '2021-06-02 16:50:52'),
(11313, 3040, 19788, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:39', '2021-03-11 17:06:39'),
(11314, 3040, 19788, NULL, '2021-03-31 00:00:00.000', 'Approved', 'Ancillary contract. No need to add individual provider. ', NULL, NULL, '2021-03-24 09:25:06', '2021-03-24 09:25:06'),
(11315, 3040, 19789, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:39', '2021-03-11 17:06:39'),
(11316, 3040, 19789, NULL, '2021-03-31 00:00:00.000', 'Initiated', 'Email sent to: pr.south@healthsmart.com  Subject:  Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under below locations.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you   ', NULL, NULL, '2021-03-24 09:24:55', '2021-03-24 09:24:55'),
(11317, 3040, 19789, NULL, '2021-04-21 00:00:00.000', 'In Process', 'Email sent to: pr.south@healthsmart.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare || Greetings,   Has there been any update?   Thanks ', NULL, NULL, '2021-04-14 07:26:02', '2021-04-14 07:26:02'),
(11318, 3040, 19789, NULL, '2021-06-08 00:00:00.000', 'In Process', 'Email sent to: vipproviders@anci-care.com  Subject: Add Locations || Tax ID# 81-5123542 || Valley Med Urgent Care PLLC || AnciCare ||  Greetings,   Hope you are doing well. I wanted to add the locations in Anci-Care for our group Valley Med Urgent Care PLLC under the below locations. Can you please send me the copt of contract.  Practice Details: Practice Name: Valley Med Urgent Care PLLC Practice Tax ID# 81-5123542 Practice NPI# 1518404631 Effective Date: 03/15/2018 Primary Location: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Additional Location: 101 E. Expressway 83, Suite #170  McAllen , TX 78501-1166  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-01 15:02:39', '2021-06-01 15:02:39'),
(11319, 3040, 19789, NULL, '2021-06-09 00:00:00.000', 'Approved', 'No need to add the providers because our group has an ancillary contract. ', NULL, NULL, '2021-06-02 16:48:12', '2021-06-02 16:48:12'),
(11320, 1006, 19790, NULL, NULL, 'New/Not Initiated', NULL, NULL, NULL, '2021-03-11 17:06:49', '2021-03-11 17:06:49'),
(11321, 1019, 19790, NULL, '2021-04-08 00:00:00.000', 'Initiated', 'Application Submitted online see attachments for reference.', NULL, NULL, '2021-03-25 14:22:55', '2021-03-25 14:22:55'),
(11322, 1019, 19790, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Sent the following email to Laura :Laura.Bevin@aetna.com  Sub: Enrollment Status || Providers || SNBCARE || Aetna Hello Laura, Hope you\'re doing well, can you please let me know about the enrollment status for following providers under our group.  Group Information: Spectrum Neuro Behavioral Care NPI: 1356906572 TAX ID: 834482753  Individual NPI:  Barbara HIgnite NPI: 1982617262 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Kerry Smith NPI: 1275083230 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Rodesia Edmundson NPI: 1124622667 Primary Location: 61 Lincoln Street, Suite 203, Framingham, MA, 01702 Secondary Location: 100 New State Highway, Raynham, MA, 02767.  Justin Souliere NPI: 1710576004 Primary Location: 63 Eddie Dowling Highway, Suite 9, North Smithfield, RI, 02896.', NULL, NULL, '2021-04-08 10:17:53', '2021-04-08 10:17:53'),
(11323, 1019, 19790, NULL, '2021-04-15 00:00:00.000', 'In Process', 'Received the following the email from Laura.Bevin@aetna.com Good afternoon,  Barbara HIgnite, 6369000 – waiting to be linked    Kerry Smith, 6164300 – CAQH application is being reviewed by our Credentialing Dept.  Rodesia Edmundson – very early in the credentialing process, application was received on 04/05/2021  Justin Souliere, 6893422 - CAQH application is being reviewed by our Credentialing Dept.     Thank you', NULL, NULL, '2021-04-08 11:31:42', '2021-04-08 11:31:42'),
(11324, 3040, 19790, NULL, '2021-04-23 00:00:00.000', 'In Process', 'I had a word with Aetna representative and he said the application was received on 03/25/2021 and still in credentialing process.   It will take up to 60 Business days. ', NULL, NULL, '2021-04-16 16:11:23', '2021-04-16 16:11:23');
