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
(39860, 20067, 30094, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 06/25/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:28:05', '2022-01-19 17:28:05'),
(39861, 1006, 30095, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39862, 3040, 30095, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 14:36:49', '2021-05-19 14:36:49'),
(39863, 3040, 30095, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:08:31', '2021-06-08 12:08:31'),
(39864, 3040, 30095, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:31:02', '2021-06-08 12:31:02'),
(39865, 3040, 30095, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:42:21', '2021-06-20 16:42:21'),
(39866, 1006, 30096, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39867, 3040, 30096, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-17 12:55:10', '2021-05-17 12:55:10'),
(39868, 3040, 30096, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:41', '2021-06-07 17:59:41'),
(39869, 3040, 30096, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:40', '2021-06-24 11:21:40'),
(39870, 3040, 30096, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:55', '2021-07-13 13:14:55'),
(39871, 1006, 30097, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39872, 1006, 30097, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:53:43', '2021-06-01 13:53:43'),
(39873, 3040, 30097, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:23', '2021-07-22 10:06:23'),
(39874, 11056, 30097, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:35', '2021-08-04 15:27:35'),
(39875, 3040, 30097, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:23', '2021-08-17 10:58:23'),
(39876, 3040, 30097, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:19', '2021-08-17 13:14:19'),
(39877, 1006, 30098, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:10', '2021-05-14 14:37:10'),
(39878, 3040, 30098, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 09:17:39', '2021-05-20 09:17:39'),
(39879, 3040, 30098, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:36:04', '2021-06-09 12:36:04'),
(39880, 3040, 30098, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:09', '2021-07-20 10:27:09'),
(39881, 3040, 30098, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:26', '2021-07-26 12:02:26'),
(39882, 1006, 30105, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39883, 3040, 30105, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:21:00', '2021-05-18 12:21:00'),
(39884, 1006, 30106, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39885, 3040, 30106, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:28', '2021-05-18 10:22:28'),
(39886, 1006, 30107, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39887, 3040, 30107, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 08:55:17', '2021-05-20 08:55:17'),
(39888, 3040, 30107, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:33', '2021-06-09 13:01:33'),
(39889, 3040, 30107, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:34', '2021-06-09 13:02:34'),
(39890, 3040, 30107, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:41:57', '2021-06-28 13:41:57'),
(39891, 3040, 30107, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:12', '2021-07-16 16:49:12'),
(39892, 11056, 30107, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:16', '2021-08-05 11:06:16'),
(39893, 12062, 30107, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:36:03', '2021-09-17 16:36:03'),
(39894, 1006, 30108, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39895, 3040, 30108, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-18 12:27:17', '2021-05-18 12:27:17'),
(39896, 3040, 30108, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:11', '2021-06-08 10:32:11'),
(39897, 3040, 30108, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:08', '2021-06-08 10:35:08'),
(39898, 3040, 30108, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:15', '2021-06-08 14:28:15'),
(39899, 1006, 30110, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39900, 3040, 30110, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:37:00', '2021-05-20 09:37:00'),
(39901, 3040, 30110, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:54:11', '2021-06-09 10:54:11'),
(39902, 3040, 30110, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:31', '2021-07-20 09:44:31'),
(39903, 11056, 30110, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:41:17', '2021-08-05 13:41:17'),
(39904, 3040, 30110, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:32', '2021-09-03 14:38:32'),
(39905, 10057, 30110, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:34', '2021-10-18 11:41:34'),
(39906, 10057, 30110, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:26', '2021-11-23 17:38:26'),
(39907, 10057, 30110, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 10:54:32', '2021-12-06 10:54:32'),
(39908, 10057, 30110, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:06', '2021-12-13 13:04:06'),
(39909, 10057, 30110, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:35', '2021-12-20 13:29:35'),
(39910, 10057, 30110, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:09', '2021-12-27 12:47:09'),
(39911, 10057, 30110, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:26', '2021-12-30 14:08:26'),
(39912, 19067, 30110, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:39:57', '2022-01-10 09:39:57'),
(39913, 20067, 30110, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:31:12', '2022-01-19 12:31:12'),
(39914, 20067, 30110, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 08/08/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-19 17:25:05', '2022-01-19 17:25:05'),
(39915, 1006, 30111, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39916, 3040, 30111, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 14:36:53', '2021-05-19 14:36:53'),
(39917, 3040, 30111, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:10:32', '2021-06-08 12:10:32'),
(39918, 3040, 30111, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:58', '2021-06-08 12:32:58'),
(39919, 3040, 30111, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:28:37', '2021-06-20 16:28:37'),
(39920, 1006, 30112, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39921, 3040, 30112, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-17 12:55:14', '2021-05-17 12:55:14'),
(39922, 3040, 30112, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:36', '2021-06-07 17:59:36'),
(39923, 3040, 30112, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:39', '2021-06-24 11:21:39'),
(39924, 3040, 30112, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:55', '2021-07-13 13:14:55'),
(39925, 1006, 30113, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39926, 1006, 30113, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:54:16', '2021-06-01 13:54:16'),
(39927, 3040, 30113, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:22', '2021-07-22 10:06:22'),
(39928, 11056, 30113, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:27', '2021-08-04 15:27:27'),
(39929, 3040, 30113, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:23', '2021-08-17 10:58:23'),
(39930, 3040, 30113, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:18', '2021-08-17 13:14:18'),
(39931, 1006, 30114, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:11', '2021-05-14 14:37:11'),
(39932, 3040, 30114, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 09:17:43', '2021-05-20 09:17:43'),
(39933, 3040, 30114, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:35:30', '2021-06-09 12:35:30'),
(39934, 3040, 30114, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:08', '2021-07-20 10:27:08'),
(39935, 3040, 30114, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:25', '2021-07-26 12:02:25'),
(39936, 1006, 30121, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:12', '2021-05-14 14:37:12'),
(39937, 3040, 30121, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:21:05', '2021-05-18 12:21:05'),
(39938, 1006, 30122, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:12', '2021-05-14 14:37:12'),
(39939, 3040, 30122, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:31', '2021-05-18 10:22:31'),
(39940, 1006, 30123, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:12', '2021-05-14 14:37:12'),
(39941, 3040, 30123, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 08:55:21', '2021-05-20 08:55:21');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(39942, 3040, 30123, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:29', '2021-06-09 13:01:29'),
(39943, 3040, 30123, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:30', '2021-06-09 13:02:30'),
(39944, 3040, 30123, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:41:55', '2021-06-28 13:41:55'),
(39945, 3040, 30123, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:11', '2021-07-16 16:49:11'),
(39946, 11056, 30123, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:06:06', '2021-08-05 11:06:06'),
(39947, 12062, 30123, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:34:30', '2021-09-17 14:34:30'),
(39948, 12062, 30123, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:40:23', '2021-09-17 16:40:23'),
(39949, 1006, 30124, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:12', '2021-05-14 14:37:12'),
(39950, 3040, 30124, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-18 12:27:20', '2021-05-18 12:27:20'),
(39951, 3040, 30124, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:06', '2021-06-08 10:32:06'),
(39952, 3040, 30124, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:35:02', '2021-06-08 10:35:02'),
(39953, 3040, 30124, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:19', '2021-06-08 14:28:19'),
(39954, 1006, 30126, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:13', '2021-05-14 14:37:13'),
(39955, 3040, 30126, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Submitted an online enrollment form for group enrollment:  \"Your form was submitted successfully. Thank you for contacting us. A representative will be in contact to discuss your interest in becoming a participating Provider.\"  Form attached in main group task.', NULL, NULL, '2021-05-20 09:37:04', '2021-05-20 09:37:04'),
(39956, 3040, 30126, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:54:15', '2021-06-09 10:54:15'),
(39957, 3040, 30126, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Wellcare representative and he advised me that processing time will take time. After reviewing the application the provider rep will contact you.  ', NULL, NULL, '2021-07-20 09:44:31', '2021-07-20 09:44:31'),
(39958, 11056, 30126, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good morning!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below locations.  Practice Details: Practice Name : Columbus Urgent Care PA Practice Tax ID # : 47-1914151 Practice NPI # : 1215330501 Practice Address : 926 Walnut St, Columbus, TX 78934-2215  Provider Details: Provider 1: Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 2: Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 3: Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4: Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 5: Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 6: Provider Name: Chennemkara, Mini Provider NPI# 1841755956  Provider 7: Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8: Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 9: Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 10: Provider Name: John, Jeny Provider NPI# 1073019493  Provider 11: Provider Name: Kourouma ,Odette 1134525868  Provider 12: Provider Name : Piccione JR, James 1356321509  Provider 13: Provider Name : Fernandus, Limy 1972005189  Provider 14: Provider Name : Thomas, Cini 1134777238  Provider 15: Provider Name : George, Jeemol 1497219067  Provider 16: Provider Name : Jose, Julie 1447883061  Provider 17: Provider Name : Rauf, Abdur 1497726202  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-05 13:41:03', '2021-08-05 13:41:03'),
(39959, 3040, 30126, NULL, '2021-09-10 00:00:00.000', 'In Process', 'I had a word with Jessie Wellcare representative and she advise that one of your provider is already participating with Wellcare. For group you need a submit a separate request. And we already send the request for ancillary contract. Please see attachment. ', NULL, NULL, '2021-09-03 14:38:31', '2021-09-03 14:38:31'),
(39960, 10057, 30126, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in Wellcare in our group under the below location. We have already forwarded an ancillary contract earlier.  Group Name	Columbus Urgent Care Tax ID	47-1914151 Group NPI	1215330501 Practice Address	926 Walnut St, Columbus , TX 78934-2215  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Looking forward to hearing from you. Have a great day.  Thanks & Regards,', NULL, NULL, '2021-10-18 11:41:26', '2021-10-18 11:41:26'),
(39961, 10057, 30126, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Enrollment Status Query - CUCC - Wellcare  Hello,  We currently have two providers PAR for this group effective 5/1/2021.  Please submit a Roster with all of the necessary information filled in for the remaining providers that you need added or you can submit your requests via our website below.  https://www.wellcare.com/en/Texas/Become-a-Provider  Join Our Network | Wellcare www.wellcare.com', NULL, NULL, '2021-11-23 17:38:19', '2021-11-23 17:38:19'),
(39962, 10057, 30126, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Request Submitted.  Please see attachment:', NULL, NULL, '2021-12-06 10:45:57', '2021-12-06 10:45:57'),
(39963, 10057, 30126, NULL, '2021-12-20 00:00:00.000', 'In Process', ' Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  Hope this email finds you in good health. Could you please provide me with the welcome packets for Abdur Rauf & James Piccione.  Furthermore, the request for other remaining providers has been submitted. Kindly revert back to me once you get any update.  Thanks & Regards,', NULL, NULL, '2021-12-13 13:04:00', '2021-12-13 13:04:00'),
(39964, 10057, 30126, NULL, '2021-12-27 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Greetings!  Any update on my below request. This is my SECOND REMINDER. Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-20 13:29:29', '2021-12-20 13:29:29'),
(39965, 10057, 30126, NULL, '2022-01-03 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com & Cynthia.Barnett@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Afternoon,  This is my THIRD REMINDER on the below mentioned request and I have still not yet got any update.  Kindly get back to me as soon as possible.  Regards,', NULL, NULL, '2021-12-27 12:47:03', '2021-12-27 12:47:03'),
(39966, 10057, 30126, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status Query - CUCC - Wellcare  Good Moring,  Here is a list of providers who are par. The rest are still in process.  Please see attachment.  Sincerely,  Network Management', NULL, NULL, '2021-12-30 14:08:20', '2021-12-30 14:08:20'),
(39967, 19067, 30126, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: ProspectiveProviderTX@wellcare.com  Subject: Enrollment Status Query - CUCC - Wellcare    Good morning,   The providers are now par. Please see roster.    PROVIDER_ID	FIRST_NAME	LAST_NAME	EFFECTIVE_DATE	NPI	IRS_TAX_ID 2819571	GLORY	ABRAHAM	12/01/2021	1194206490	471914151 2819342	JEENA	ABRAHAM	12/01/2021	1467901587	471914151 2819600	BRITTANY	BROWN	12/01/2021	1275163537	471914151 2799031	MINI	CHENNEMKARA	06/25/2021	1841755956	471914151 2799319	LIMY	FERNANDUS	02/25/2021	1972005189	471914151 2798161	JEEMOL	GEORGE	12/08/2021	1497219067	471914151 2798172	JAYA	JACOB	12/08/2021	1194336149	471914151 2799505	JULIE	JOSE	09/30/2020	1447883061	471914151 2796048	MOLLY	JOSEPH	11/21/2021	1396380077	471914151 2799274	VIBITHA	JOSEPH	06/24/2020	1952931560	471914151 2798134	ODETTE	KOUROUMA	12/08/2021	1134525868	471914151 2799018	SIGI	PAUL	08/08/2021	1033623616	471914151 2494093	JAMES	PICCIONE	05/03/2021	1356321509	471914151 2499814	ABDUR	RAUF	05/03/2021	1497726202	471914151 2800692	ANI	STEPHEN	12/08/2021	1588959118	471914151 2799016	CINI	THOMAS	07/09/2021	1134777238	471914151   Sincerely,', NULL, NULL, '2022-01-10 09:40:06', '2022-01-10 09:40:06'),
(39968, 20067, 30126, NULL, '2022-01-26 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com, Cynthia.Barnett@wellcare.com  Sub: Re: Enrollment Status Query - CUCC - Wellcare  Good Morning! Hope all is well with you. Could you please facilitate us with the welcome kit of these providers.  Thanks and Regards, Syed Ahad.', NULL, NULL, '2022-01-19 12:27:34', '2022-01-19 12:27:34'),
(39969, 20067, 30126, NULL, '2022-01-26 00:00:00.000', 'Approved', 'Received the following email from WellCare  Good Afternoon,   Please see welcome letter and roster of providers that were loaded:  Effective Date: 12/08/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-19 17:21:35', '2022-01-19 17:21:35'),
(39970, 1006, 30127, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:13', '2021-05-14 14:37:13'),
(39971, 3040, 30127, NULL, '2021-05-26 00:00:00.000', 'In Process', 'Email sent to: mflores@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in TRPN in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-19 14:36:57', '2021-05-19 14:36:57'),
(39972, 3040, 30127, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: mflores@trpnppo.com  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN || Adil,     I will send this over to our data entry team to update in the system accordingly. Thank you, have a great afternoon.     Best regards,  Max Flores', NULL, NULL, '2021-06-08 12:10:26', '2021-06-08 12:10:26'),
(39973, 3040, 30127, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN | Greetings,   Hope you are doing well. Please find the attached Provider Update Forms as per email received from Carlos Campos.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-08 12:32:54', '2021-06-08 12:32:54'),
(39974, 3040, 30127, NULL, '2021-06-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || TRPN ||  Hi Adil,  Provider Jeemol George is Active, effective date 01/01/2019  Provider Jose Julie is Active, effective date 05/25/2021  Provider Ani Stephen is Active, effective date 05/25/2021  Provider James Piccione is Active, effective date 05/25/2021  Provider Brittany Brown is Active, effective date 05/25/2021  Provider Mini Chennemkara is Active, effective date 05/25/2021  Provider Glory Abraham is Active, effective date 05/25/2021  Provider Limy Fernandus is Active, effective date 05/25/2021  Provider Abdur Rauf is Active, effective date 05/25/2021  Provider Odette Kourouma is Active, effective date 05/25/2021  Provider Vibitha Joseph is Active, effective date 05/25/2021  Provider Cini Thomas is Active, effective date 10/01/2019  Provider Jeena Abraham is Active, effective date 05/25/2021  Provider Sigi Paul is Active, effective date 05/25/2021  Provider Jaya Jacob is Active, effective date 05/25/2021', NULL, NULL, '2021-06-20 16:24:54', '2021-06-20 16:24:54'),
(39975, 1006, 30128, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:13', '2021-05-14 14:37:13'),
(39976, 3040, 30128, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-17 12:55:23', '2021-05-17 12:55:23'),
(39977, 3040, 30128, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,  Has there been any update? Thanks', NULL, NULL, '2021-06-07 17:59:30', '2021-06-07 17:59:30'),
(39978, 3040, 30128, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:39', '2021-06-24 11:21:39'),
(39979, 3040, 30128, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:14:55', '2021-07-13 13:14:55'),
(39980, 3040, 30128, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'County not covered by insurance. ', NULL, NULL, '2021-07-13 13:15:14', '2021-07-13 13:15:14'),
(39981, 1006, 30129, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:13', '2021-05-14 14:37:13'),
(39982, 1006, 30129, NULL, '2021-06-08 00:00:00.000', 'On Hold', 'Ancillary enrollment request is submitted, check group task for reference. ', NULL, NULL, '2021-06-01 13:53:58', '2021-06-01 13:53:58'),
(39983, 3040, 30129, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-22 10:06:22', '2021-07-22 10:06:22'),
(39984, 11056, 30129, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:17', '2021-08-04 15:27:17'),
(39985, 3040, 30129, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:22', '2021-08-17 10:58:22'),
(39986, 3040, 30129, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:18', '2021-08-17 13:14:18'),
(39987, 1006, 30130, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:13', '2021-05-14 14:37:13'),
(39988, 3040, 30130, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 09:17:47', '2021-05-20 09:17:47'),
(39989, 3040, 30130, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Group enrollment request sent. Waiting for the contract. ', NULL, NULL, '2021-06-09 12:35:25', '2021-06-09 12:35:25'),
(39990, 3040, 30130, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-20 10:27:08', '2021-07-20 10:27:08'),
(39991, 3040, 30130, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-26 12:02:25', '2021-07-26 12:02:25'),
(39992, 1006, 30137, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:14', '2021-05-14 14:37:14'),
(39993, 3040, 30137, NULL, '2021-05-25 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Columbus, we are unable to enroll with them.   Please take a look at the cities listed here @ https://myrpo.com/providers/how-to-join', NULL, NULL, '2021-05-18 12:21:09', '2021-05-18 12:21:09'),
(39994, 1006, 30138, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:14', '2021-05-14 14:37:14'),
(39995, 3040, 30138, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. Contract attached in group task. ', NULL, NULL, '2021-05-18 10:22:35', '2021-05-18 10:22:35'),
(39996, 1006, 30139, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:14', '2021-05-14 14:37:14'),
(39997, 3040, 30139, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 08:55:26', '2021-05-20 08:55:26'),
(39998, 3040, 30139, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: austin.owens@primehealthservices.com  Subject: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Thank you, I have sent this over to our Updates department to complete.  Best,  Austin Owens Provider Contracting Specialist', NULL, NULL, '2021-06-09 13:01:24', '2021-06-09 13:01:24'),
(39999, 3040, 30139, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject:  Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   Hope you are doing well. I wanted to know if there is any update regarding the enrollment that was requested in my previous email.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-09 13:02:27', '2021-06-09 13:02:27'),
(40000, 3040, 30139, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to: austin.owens@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello Austin,   I didn\'t receive any email from your department regarding the request that was sent out 05/20/2021. Can you please check and advise how to proceed with enrollment?  Waiting for your reply.   Thank you ', NULL, NULL, '2021-06-28 13:42:12', '2021-06-28 13:42:12'),
(40001, 3040, 30139, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to: updates@primehealthservices.com  Subject: Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-16 16:49:10', '2021-07-16 16:49:10'),
(40002, 11056, 30139, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email sent to : 	austin.owens@primehealthservices.com  Sub : Re: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Good morning!  Hope you are doing well. I wanted to enroll the below mentioned providers in Prime Health Services in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider Details: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 9:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 11:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 12 : Provider Name : John, Jeny Provider NPI# : 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day!    I have called Prime Health services thrice. But no one pickup the call & there was a recorder which inform me that they are working from home due to COVID after the recorder we have recorded our message and sent the voice mail for updation regarding our enrollment request.', NULL, NULL, '2021-08-05 11:05:55', '2021-08-05 11:05:55'),
(40003, 12062, 30139, NULL, '2021-09-25 00:00:00.000', 'In Process', 'Sent a follow up email to :austin.owens@primehealthservices.com  Subject: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Dear Owens,  Good Day!  May I have the updated status on below?  I would appreciate your earliest response for a subject query.  Have a nice weekend ! ', NULL, NULL, '2021-09-17 14:35:13', '2021-09-17 14:35:13'),
(40004, 12062, 30139, NULL, '2021-09-25 00:00:00.000', 'Approved', 'As per the below mail the provider is enrolled. See attached file and below mail for a reference.  from:providerrelations@primehealthservices.com Subject:Re: RE: Enroll Providers || Columbus Urgent Care PA || Prime Health Services ||  Hello,  Please see updates highlighted in yellow, as all listed providers are enrolled under this group.   Thank you, Provider Relations   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067 Enrolled effective: 08/10/2020 Provider ID:11731313   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 Enrolled effective: 08/10/2020 Provider ID: 11548953   Provider 3:   Provider Name: Brown, Brittany Provider NPI# 1275163537 Enrolled effective: 08/10/2020 Provider ID: 11418820  Provider 4:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 Enrolled effective: 08/10/2020 Provider ID:    Provider 5:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 Enrolled effective: 08/10/2020 Provider ID: 12276289   Provider 6:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 Enrolled effective: 08/10/2020 Provider ID: 7163504   Provider 7:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 Enrolled effective: 08/10/2020 Provider ID: 11548952   Provider 8:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 Enrolled effective: 08/10/2020 Provider ID: 12504178   Provider 9:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 Enrolled effective: 08/10/2020 Provider ID: 12504179   Provider 10:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 Enrolled effective: 08/10/2020 Provider ID: 12504180', NULL, NULL, '2021-09-17 16:40:59', '2021-09-17 16:40:59'),
(40005, 1006, 30140, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:19', '2021-05-14 14:37:19'),
(40006, 3040, 30140, NULL, '2021-05-25 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org, enterprise.credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Memorial Hermann in our group Columbus Urgent Care PA under below locations.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-18 12:27:24', '2021-05-18 12:27:24'),
(40007, 3040, 30140, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: Enterprise.Credentialing@memorialhermann.org  Subject:Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Hello,   Yes, the providers applying for MH Health Plan. Please advise how the provider gets credentialed/enrolled with MH Health Plan.   Thank you  ', NULL, NULL, '2021-06-08 10:32:01', '2021-06-08 10:32:01'),
(40008, 3040, 30140, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann || Hello,  Are the providers below applying for MH Health Plan? Looping in Contracting to provide some guidance.  Thank you!', NULL, NULL, '2021-06-08 10:34:36', '2021-06-08 10:34:36'),
(40009, 3040, 30140, NULL, '2021-06-15 00:00:00.000', 'Not Eligible', 'Email rcvd from: Enterprise.Credentialing@memorialhermann.org  Subject: Need to Enroll || Columbus Urgent Care PA || Group & Providers || Memorial Hermann ||  Good morning. At this time, Columbus, Texas is out of our network area, and we do not contract out of network at this time. Please let me know if you have any questions.  Thank you. Camilla Paige', NULL, NULL, '2021-06-08 14:28:23', '2021-06-08 14:28:23'),
(40010, 1006, 30141, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:19', '2021-05-14 14:37:19'),
(40011, 3040, 30141, NULL, '2021-05-24 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Christus Spohn in our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-17 12:55:27', '2021-05-17 12:55:27'),
(40012, 3040, 30141, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:Group & Providers || Columbus Urgent Care PA || Group & Providers || Christus Spohn ||  Greetings,   Has there been any update?  Thanks ', NULL, NULL, '2021-06-08 14:04:41', '2021-06-08 14:04:41'),
(40013, 3040, 30141, NULL, '2021-07-01 00:00:00.000', 'In Process', 'I had a word with (VICKI) in Christus Spohn provider relation department and she advised the insurance will not provider the services in Colorado county. I requested her to send me an email so I can update in my system. Once we received the email will update accordingly.   ', NULL, NULL, '2021-06-24 11:21:38', '2021-06-24 11:21:38'),
(40014, 3040, 30141, NULL, '2021-07-20 00:00:00.000', 'Not Eligible', 'As per Michal simms email they not covered the Colorado county. For more details please see attachment. ', NULL, NULL, '2021-07-13 13:13:04', '2021-07-13 13:13:04'),
(40015, 1006, 30142, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:20', '2021-05-14 14:37:20'),
(40016, 1006, 30142, NULL, '2021-06-08 00:00:00.000', 'Initiated', 'Submitted ancillary enrollment request @ TXMAContracting@cigna.com:  Sub: Enrollment Request - CUCC - Cigna Healthspring  \"Hello,   Please find the attached ancillary enrollment request form for our group, do let me know if anything else is required and what the next steps are, and how long this request will take for enrollment?  Thank you.\"  Form attached for reference in the group task. ', NULL, NULL, '2021-06-01 13:52:47', '2021-06-01 13:52:47'),
(40017, 3040, 30142, NULL, '2021-06-29 00:00:00.000', 'In Process', 'Email sent to: TXMAContracting@cigna.com,   Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-22 10:52:35', '2021-06-22 10:52:35'),
(40018, 3040, 30142, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring under the below location.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Waiting for your response.   Thank you ', NULL, NULL, '2021-07-12 14:22:09', '2021-07-12 14:22:09');
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
(40019, 11056, 30142, NULL, '2021-08-12 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Enrollment Request - CUCC - Cigna Healthspring  Thank you! I will provide this to our network committee to review at our next committee meeting. The meeting will take place at the end of the month, and I will be able to provide you an update closer to this time.        Jennifer Perez  Network Operations Senior Analyst | Cigna-Medicare  2800 North Loop West, Suite 400 | Houston, Texas 77092', NULL, NULL, '2021-08-04 15:27:08', '2021-08-04 15:27:08'),
(40020, 3040, 30142, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  Hello Jennifer,   Hope you are doing well. I wanted to get an update regarding the enrollment request for the below mentioned facility. As per your previous email the network committee will review the request. We requested an ancillary contract for our facility.   Practice Name: Columbus Urgent Care PA Practice Tax ID#  471914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus TX, 78934  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-08-17 10:58:22', '2021-08-17 10:58:22'),
(40021, 3040, 30142, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:11:47', '2021-08-17 13:11:47'),
(40022, 3040, 30142, NULL, '2021-08-24 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Enrollment Request - CUCC - Cigna Healthspring  August 17, 2021 Attn: Brad Peterson RE: Network Interest Form Denial Dear Columbus Urgent Care PA : Thank you for your interest in participating with Cigna-HealthSpring® to provide service to our Medicare Advantage customers. The information you provided in your Network Interest Form was reviewed by the Network Interest Committee on 8/5/21. At this time, it has been determined there is not a need for additional providers in our network specific to your practice area and geographic location. However, we will keep your Network Interest Profile Form on file should our network needs change in the future.  We appreciate your interest in Cigna-HealthSpring.  Sincerely, South Texas Network Operations', NULL, NULL, '2021-08-17 13:14:15', '2021-08-17 13:14:15'),
(40023, 1006, 30143, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:20', '2021-05-14 14:37:20'),
(40024, 3040, 30143, NULL, '2021-05-27 00:00:00.000', 'In Process', 'Email sent to: ccnprovider@triwest.com  Subject: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group & providers in Triwest for our group Columbus Urgent Care PA under below locations.  Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-20 09:17:52', '2021-05-20 09:17:52'),
(40025, 3040, 30143, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Rita) Triwest provider services and she advise to fill out the online application for enrollment. After reviewing the application we will received the contract for sign. I already submit the request online through Triwest website. Below are the submitted application details: Request Id: 150673 Request was successfully saved.', NULL, NULL, '2021-06-09 12:32:49', '2021-06-09 12:32:49'),
(40026, 3040, 30143, NULL, '2021-07-05 00:00:00.000', 'In Process', 'I had a word Chris and he said once the application submitted it will take 60 business days to review the request and after that provider rep department decided either they need our services in the area or not.   Ref: PH-1330284-J1G9T4', NULL, NULL, '2021-06-28 14:03:14', '2021-06-28 14:03:14'),
(40027, 3040, 30143, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to; jmonson@triwest.com  Subject: Re: FW: Enroll Group & Providers || Columbus Urgent Care PA || TriWest ||  Hello Jess,   Hope you are doing well. Please advise me the enrollment status for the below mentioned group in Triwest in our group Columbus Urgent Care PA under the below location.   Practice Details: Practice Name: Columbus Urgent Care PA Practice Tax ID# 47-1914151 Practice NPI# 1215330501 Practice Address: 926 Walnut St, Columbus , TX 78934-2215  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-19 08:30:26', '2021-07-19 08:30:26'),
(40028, 3040, 30143, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Email rcvd from: providerservices@triwest.com  Subject: TriWest Healthcare Alliance Provider Agreement 121TW75182  Dear Provider,  Thank you for joining the Department of Veterans Affairs (VA) Community Care Network (CCN) through TriWest Healthcare Alliance (TriWest). This letter confirms that your TriWest CCN contract has been signed and executed.   ', NULL, NULL, '2021-07-26 12:00:46', '2021-07-26 12:00:46'),
(40029, 1006, 30144, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:37:20', '2021-05-14 14:37:20'),
(40030, 3040, 30144, NULL, '2021-05-25 00:00:00.000', 'Approved', 'Facility has an ancillary contract. Group contract attached.   Effective Date: 03/15/2020. ', NULL, NULL, '2021-05-18 10:20:22', '2021-05-18 10:20:22'),
(40031, 1006, 30145, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40032, 3040, 30145, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 13:23:35', '2021-05-28 13:23:35'),
(40033, 3040, 30145, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:40:47', '2021-06-16 16:40:47'),
(40034, 3040, 30145, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:25', '2021-07-20 10:52:25'),
(40035, 11056, 30145, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 16:15:37', '2021-08-12 16:15:37'),
(40036, 3040, 30145, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:37', '2021-08-27 10:00:37'),
(40037, 1006, 30147, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40038, 1006, 30147, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 20:59:28', '2021-05-20 20:59:28'),
(40039, 3040, 30147, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:44:27', '2021-06-09 10:44:27'),
(40040, 3040, 30147, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:19', '2021-07-20 10:36:19'),
(40041, 11056, 30147, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:50:51', '2021-08-11 13:50:51'),
(40042, 3040, 30147, NULL, '2021-09-14 00:00:00.000', 'Approved', 'Email rcvd from: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please see providers we have currently loaded:  For more details please see attachment.   Thanks ', NULL, NULL, '2021-09-07 15:16:56', '2021-09-07 15:16:56'),
(40043, 1006, 30148, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40044, 3040, 30148, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:53:21', '2021-05-27 12:53:21'),
(40045, 3040, 30148, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-06-15 14:38:22', '2021-06-15 14:38:22'),
(40046, 3040, 30148, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:04:32', '2021-07-05 10:04:32'),
(40047, 3040, 30148, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:24', '2021-07-22 10:01:24'),
(40048, 11056, 30148, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:35:28', '2021-08-12 11:35:28'),
(40049, 10057, 30148, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:44:15', '2021-10-08 10:44:15'),
(40050, 10057, 30148, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:24:37', '2021-11-23 17:24:37'),
(40051, 10057, 30148, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:16:15', '2021-12-03 15:16:15'),
(40052, 10057, 30148, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:12:27', '2021-12-10 13:12:27'),
(40053, 10057, 30148, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:48:34', '2021-12-17 10:48:34'),
(40054, 10057, 30148, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:40:28', '2021-12-23 10:40:28'),
(40055, 19067, 30148, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:41:57', '2022-01-04 17:41:57'),
(40056, 20067, 30148, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:29:49', '2022-01-14 15:29:49'),
(40057, 20067, 30148, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:05:52', '2022-01-24 10:05:52'),
(40058, 20067, 30148, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:06:03', '2022-02-02 16:06:03'),
(40059, 20067, 30148, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:08:48', '2022-03-01 15:08:48'),
(40060, 20067, 30148, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:58:04', '2022-03-17 17:58:04'),
(40061, 22077, 30148, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:11:07', '2022-04-15 08:11:07'),
(40062, 22077, 30148, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:21:03', '2022-04-19 13:21:03'),
(40063, 22077, 30148, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:30:01', '2022-04-19 13:30:01'),
(40064, 1006, 30149, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40065, 3040, 30149, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 16:57:41', '2021-05-28 16:57:41'),
(40066, 11056, 30149, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:23:59', '2021-06-16 17:23:59'),
(40067, 3040, 30149, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:53', '2021-07-05 15:25:53'),
(40068, 3040, 30149, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:54', '2021-07-20 08:32:54'),
(40069, 1006, 30150, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40070, 1006, 30150, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:16:57', '2021-05-31 16:16:57'),
(40071, 3040, 30150, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:51:25', '2021-06-18 11:51:25');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(40072, 3040, 30150, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:46:51', '2021-07-06 14:46:51'),
(40073, 3040, 30150, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:48', '2021-07-27 16:53:48'),
(40074, 3040, 30150, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:48', '2021-07-28 11:20:48'),
(40075, 1006, 30151, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40076, 3040, 30151, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:34:58', '2021-06-02 10:34:58'),
(40077, 3040, 30151, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:43', '2021-07-22 10:04:43'),
(40078, 11056, 30151, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:00:14', '2021-08-09 09:00:14'),
(40079, 3040, 30151, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:56:00', '2021-08-17 09:56:00'),
(40080, 10057, 30151, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:19:57', '2021-10-14 11:19:57'),
(40081, 10057, 30151, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 15:07:59', '2021-11-18 15:07:59'),
(40082, 10057, 30151, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:53:25', '2021-12-01 11:53:25'),
(40083, 10057, 30151, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:31:53', '2021-12-08 10:31:53'),
(40084, 10057, 30151, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:06:48', '2021-12-16 11:06:48'),
(40085, 10057, 30151, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:14:40', '2021-12-22 10:14:40'),
(40086, 10057, 30151, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:23:19', '2021-12-29 11:23:19'),
(40087, 19067, 30151, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:23:37', '2022-01-05 11:23:37'),
(40088, 19067, 30151, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:35:27', '2022-01-06 16:35:27'),
(40089, 20067, 30151, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:11:44', '2022-01-14 14:11:44'),
(40090, 20067, 30151, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:46:51', '2022-01-14 14:46:51'),
(40091, 1006, 30152, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40092, 3040, 30152, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:57:41', '2021-05-31 14:57:41'),
(40093, 3040, 30152, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:15:14', '2021-06-18 10:15:14'),
(40094, 3040, 30152, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:13', '2021-07-20 11:05:13'),
(40095, 3040, 30152, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:54', '2021-07-22 14:31:54'),
(40096, 1006, 30153, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:57', '2021-05-14 14:46:57'),
(40097, 3040, 30153, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:31:20', '2021-05-20 16:31:20'),
(40098, 1006, 30165, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40099, 3040, 30165, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 13:58:20', '2021-05-31 13:58:20'),
(40100, 3040, 30165, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:43:46', '2021-06-17 14:43:46'),
(40101, 3040, 30165, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:46', '2021-07-05 16:48:46'),
(40102, 3040, 30165, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:49', '2021-07-26 12:43:49'),
(40103, 11056, 30165, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:23:58', '2021-08-11 16:23:58'),
(40104, 3040, 30165, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:12:05', '2021-08-18 13:12:05'),
(40105, 1006, 30166, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40106, 3040, 30166, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:25:37', '2021-05-28 14:25:37'),
(40107, 10057, 30166, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:37:50', '2021-12-30 15:37:50'),
(40108, 19067, 30166, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace ||     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:21:59', '2022-01-05 17:21:59'),
(40109, 20067, 30166, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:18:15', '2022-01-18 09:18:15'),
(40110, 20067, 30166, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:17:27', '2022-01-28 09:17:27'),
(40111, 20067, 30166, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:28:09', '2022-02-09 15:28:09'),
(40112, 20067, 30166, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:30:39', '2022-02-21 09:30:39'),
(40113, 20067, 30166, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:09:37', '2022-03-01 14:09:37'),
(40114, 20067, 30166, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:12:14', '2022-03-01 14:12:14'),
(40115, 20067, 30166, NULL, '2022-03-25 00:00:00.000', 'Approved', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:48:48', '2022-03-18 10:48:48'),
(40116, 1006, 30167, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40117, 1019, 30167, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:49:54', '2021-05-31 14:49:54'),
(40118, 3040, 30167, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:21:51', '2021-06-18 13:21:51'),
(40119, 3040, 30167, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:25:47', '2021-06-18 13:25:47'),
(40120, 3040, 30167, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:31', '2021-07-07 16:52:31'),
(40121, 3040, 30167, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:27', '2021-07-22 11:56:27'),
(40122, 11056, 30167, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:10:01', '2021-08-12 10:10:01');
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
(40123, 12062, 30167, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537   Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616   Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:29:05', '2021-09-17 12:29:05'),
(40124, 10057, 30167, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:16:12', '2021-10-28 15:16:12'),
(40125, 10057, 30167, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:35:00', '2021-11-22 10:35:00'),
(40126, 10057, 30167, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:58:47', '2021-12-02 13:58:47'),
(40127, 10057, 30167, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:43:01', '2021-12-15 10:43:01'),
(40128, 10057, 30167, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:07:21', '2021-12-22 12:07:21'),
(40129, 10057, 30167, NULL, '2022-01-05 00:00:00.000', 'Approved', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:23:44', '2021-12-29 14:23:44'),
(40130, 1006, 30168, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40131, 3040, 30168, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 12:31:03', '2021-05-25 12:31:03'),
(40132, 3040, 30168, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-11 15:49:38', '2021-06-11 15:49:38'),
(40133, 11056, 30168, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 13:00:36', '2021-06-29 13:00:36'),
(40134, 3040, 30168, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:58', '2021-07-19 09:23:58'),
(40135, 3040, 30168, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:30', '2021-07-28 11:39:30'),
(40136, 11056, 30168, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:04:54', '2021-08-11 17:04:54'),
(40137, 3040, 30168, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:03:03', '2021-08-17 15:03:03'),
(40138, 3040, 30168, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:15:24', '2021-09-14 16:15:24'),
(40139, 12062, 30168, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:08:15', '2021-09-22 13:08:15'),
(40140, 10057, 30168, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:30:27', '2021-10-18 16:30:27'),
(40141, 10057, 30168, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can someone please get back to me with an update on our applications for providers, I have attached our group roster, also if there should be any concerned person who will help me out with my queries rather than sending everyone an email for an update, and also our applications are stuck now for way too much time.  If they are completed please provide me with the effective dates and Copy of there Welcome Letters / Contract.  Regards, Alex', NULL, NULL, '2021-11-10 17:43:01', '2021-11-10 17:43:01'),
(40142, 10057, 30168, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good afternoon,  All 3 facilities are awaiting the November Credentials Committee Meeting that is scheduled for November 16, 2021. If you have not received Welcome Letters by December 1st, then please send another email to CHRISTUS.HP.Credentialing@christushealth.org requesting the letters. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254', NULL, NULL, '2021-11-10 17:46:11', '2021-11-10 17:46:11'),
(40143, 10057, 30168, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:41:22', '2021-11-18 13:41:22'),
(40144, 10057, 30168, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:44:32', '2021-12-01 10:44:32'),
(40145, 10057, 30168, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:51:18', '2021-12-14 09:51:18'),
(40146, 10057, 30168, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:38:47', '2021-12-20 13:38:47'),
(40147, 10057, 30168, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:56:19', '2021-12-28 11:56:19'),
(40148, 19067, 30168, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:26:50', '2022-01-04 17:26:50'),
(40149, 19067, 30168, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:35:55', '2022-01-05 11:35:55'),
(40150, 20067, 30168, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:32:15', '2022-01-14 13:32:15'),
(40151, 20067, 30168, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:50:37', '2022-01-21 16:50:37'),
(40152, 20067, 30168, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:41:19', '2022-01-25 17:41:19'),
(40153, 1006, 30169, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40154, 3040, 30169, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 13:23:43', '2021-05-28 13:23:43'),
(40155, 3040, 30169, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:40:44', '2021-06-16 16:40:44'),
(40156, 3040, 30169, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:24', '2021-07-20 10:52:24'),
(40157, 11056, 30169, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 16:15:44', '2021-08-12 16:15:44'),
(40158, 3040, 30169, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:36', '2021-08-27 10:00:36'),
(40159, 1006, 30171, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40160, 1006, 30171, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 20:59:23', '2021-05-20 20:59:23'),
(40161, 3040, 30171, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:44:31', '2021-06-09 10:44:31'),
(40162, 3040, 30171, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:18', '2021-07-20 10:36:18'),
(40163, 11056, 30171, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:50:58', '2021-08-11 13:50:58'),
(40164, 3040, 30171, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:11', '2021-09-07 16:28:11'),
(40165, 10057, 30171, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:45:54', '2021-10-19 11:45:54'),
(40166, 10057, 30171, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:12:35', '2021-11-22 14:12:35'),
(40167, 10057, 30171, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:08:07', '2021-12-02 15:08:07'),
(40168, 10057, 30171, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:18:29', '2021-12-09 13:18:29'),
(40169, 10057, 30171, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:07:47', '2021-12-17 14:07:47'),
(40170, 10057, 30171, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:18:34', '2021-12-23 11:18:34'),
(40171, 10057, 30171, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:51:36', '2021-12-30 13:51:36'),
(40172, 20067, 30171, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:29:42', '2022-01-06 12:29:42'),
(40173, 20067, 30171, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:47:11', '2022-01-14 16:47:11'),
(40174, 20067, 30171, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 05/03/2021 Attached is the group roster and welcome letter for the provider', NULL, NULL, '2022-01-20 17:01:13', '2022-01-20 17:01:13'),
(40175, 1006, 30172, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40176, 3040, 30172, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:53:26', '2021-05-27 12:53:26'),
(40177, 3040, 30172, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-06-15 14:38:20', '2021-06-15 14:38:20'),
(40178, 3040, 30172, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:04:30', '2021-07-05 10:04:30');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(40179, 3040, 30172, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:23', '2021-07-22 10:01:23'),
(40180, 11056, 30172, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:35:35', '2021-08-12 11:35:35'),
(40181, 10057, 30172, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:44:07', '2021-10-08 10:44:07'),
(40182, 10057, 30172, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:24:30', '2021-11-23 17:24:30'),
(40183, 10057, 30172, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:16:08', '2021-12-03 15:16:08'),
(40184, 10057, 30172, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:12:21', '2021-12-10 13:12:21'),
(40185, 10057, 30172, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:48:28', '2021-12-17 10:48:28'),
(40186, 10057, 30172, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:40:20', '2021-12-23 10:40:20'),
(40187, 19067, 30172, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:41:51', '2022-01-04 17:41:51'),
(40188, 20067, 30172, NULL, '2022-01-21 00:00:00.000', 'In Process', '', NULL, NULL, '2022-01-14 15:29:24', '2022-01-14 15:29:24'),
(40189, 20067, 30172, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:29:41', '2022-01-14 15:29:41'),
(40190, 20067, 30172, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:05:46', '2022-01-24 10:05:46'),
(40191, 20067, 30172, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:05:56', '2022-02-02 16:05:56'),
(40192, 20067, 30172, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:08:43', '2022-03-01 15:08:43'),
(40193, 20067, 30172, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:58:11', '2022-03-17 17:58:11'),
(40194, 22077, 30172, NULL, '2022-04-22 00:00:00.000', 'In Process', 'Email sent to: \"dmarley@ghn-mci.com,kavalos@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Any updates on the previously mentioned request?  I am looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-15 08:10:38', '2022-04-15 08:10:38'),
(40195, 22077, 30172, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email received from: dmarley@ghn-mci.com  Subject: RE: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Dear Alex,     Please be advised that I am currently working with Syed Ahad to resolve issues with the Long Point Medical Center Agreement. Once those issues are resolved then we can move forward and address issues with your company’s other groups.     Thanks,     Daniel M.  Contract Specialist  Galaxy Health Network  (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2022-04-19 13:20:51', '2022-04-19 13:20:51'),
(40196, 22077, 30172, NULL, '2022-04-26 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hi,  Unfortunately, Syed Ahad no longer works here, I will be handling the credentialing now. Do update me about the queries and whenever you want some document or information I\'d be happy to assist you on that.', NULL, NULL, '2022-04-19 13:29:49', '2022-04-19 13:29:49'),
(40197, 1006, 30173, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40198, 3040, 30173, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Sent the following initiation request to trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Provider Enrollment Request - NUCC- TRPN  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Multiplan for our group under the below locations. Can you please send the roster.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-28 16:57:46', '2021-05-28 16:57:46'),
(40199, 11056, 30173, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Good Evening!  Hope you are doing well. Please find the attached Provider update form to enroll the below mentioned group and providers in TRPN for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429P Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:-  Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118   Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067    Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI :  1497726202    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-16 17:23:31', '2021-06-16 17:23:31'),
(40200, 3040, 30173, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, mflores@trpnppo.com, ccampos@trpnppo.com  Subject: Re: Provider Update Information Form- TRPN  Hello Max and Carlos,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in TRPN for our group under the below mentioned locations. We already sent the provider update form at trpndataentry@trpnppo.com.   Practice Details: Practice Name: Normandy Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429 Primary Address: 779 Normandy St Ste 114 Houston, TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice NPI: 1407171077 Practice TIN: 27-0796429  Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider Names enlisted below:- Provider 1: Provider Name: Joseph, Molly Provider NPI : 1396380077  Provider 2: Provider Name:  Jacob, Jaya Provider NPI : 1194336149   Provider 3: Provider Name:  PAUL, SIGI Provider NPI : 1033623616  Provider 4:  Provider Name: Chennemkara, Mini Provider NPI : 1841755956     Provider 5:   Provider Name:  Abraham, Jeena Provider NPI :  1467901587    Provider 6:   Provider Name:  Kourouma , Odette Provider NPI :  1134525868  Provider 7:   Provider Name:  Piccione JR, James Provider NPI :  1356321509    Provider 8: Provider Name:  Abraham, Glory Provider NPI :  1194206490   Provider 9:   Provider Name:  Fernandus, Limy Provider NPI :  1972005189  Provider 10: Provider Name:  Thomas, Cini Provider NPI :  1134777238  Provider 11:   Provider Name:  Stephen, Ani Provider NPI :  1588959118  Provider 12:   Provider Name:  George, Jeemol Provider NPI :  1497219067   Provider 13:   Provider Name:  Jose, Julie Provider NPI :  1447883061    Provider 14:   Provider Name:  Brown, Brittany Provider NPI :   1275163537  Provider 15:   Provider Name:  Joseph, Vibitha Provider NPI :   1952931560    Provider 16:  Provider Name:  Abdur Rauf Provider NPI : 1497726202    Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 15:25:52', '2021-07-05 15:25:52'),
(40201, 3040, 30173, NULL, '2021-07-27 00:00:00.000', 'Approved', 'Email rcvd from: ccampos@trpnppo.com  Subject: Provider Update Information Form- TRPN Hi,  Provider Molly Joseph is Active, effective date 01/01/2021,  Provider Jacob Jaya is Active, effective date 01/01/2021,  Provider Sigi Paul is Active, effective date 01/01/2021,  Provider Mini Chennemkara is Active, effective date 01/01/2021,  Provider Jeena Abraham is Active, effective date 03/01/2016,  Provider Odette Kourouma is Active, effective date 01/01/2021,  Provider James Piccione is Active, effective date 01/01/2021,  Provider Glory Abraham is Active, effective date 05/29/2019,  Provider Limy Fernandus is Active, effective date 01/01/2021,  Provider Cini Thomas is Active, effective date 10/01/2019,  Provider Ani Stephen is Active, effective date 01/01/2021,  Provider Jeemol George is Active, effective date 06/09/2020,  Provider Julie Jose is Active, effective date 06/09/2020,  Provider Brittany Brown is Active, effective date 01/01/2021,  Provider Vibitha Joseph is Active, effective date 01/01/2021,  Provider Abdur Rauf is Active, effective date 01/01/2021,  Carlos Campos  Data Entry Department Supervisor Three Rivers Provider Network 6970 O’Bannon Drive Las Vegas, NV 89117 P: 619.869.8940 F: 619.271.2563 ccampos@trpnppo.com trpndataentry@trpnppo.com', NULL, NULL, '2021-07-20 08:32:52', '2021-07-20 08:32:52'),
(40202, 1006, 30174, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40203, 1006, 30174, NULL, '2021-06-07 00:00:00.000', 'Initiated', 'Sent following initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - NUCC, IVUC - Christus Spohn  \"Hello,  We wish to enroll the following providers under the mentioned group, please let me know what is required to get the enrollment process started. the details are as follows: Group Name: Normandy Urgent Care Center NPI# 1407171077 TIN# 27-0796429  Primary Address: 779 Normandy St Ste 114, Houston, TX 77015-3441 Secondary Address: 16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-05-31 16:16:33', '2021-05-31 16:16:33'),
(40204, 3040, 30174, NULL, '2021-06-25 00:00:00.000', 'In Process', 'I called the 800-419-3461 and left the VM. Because I didn\'t getting any reply from the insurance.  ', NULL, NULL, '2021-06-18 11:51:23', '2021-06-18 11:51:23'),
(40205, 3040, 30174, NULL, '2021-07-13 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: John, Jeny Provider NPI# 1073019493  Provider 17:   Provider Name: Joseph, Molly Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-06 14:46:50', '2021-07-06 14:46:50'),
(40206, 3040, 30174, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Spohn ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Spohn for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you\'re able to.  Thank you   ', NULL, NULL, '2021-07-27 16:53:47', '2021-07-27 16:53:47'),
(40207, 3040, 30174, NULL, '2021-08-04 00:00:00.000', 'Not Eligible', 'Christus Spohn didn\'t provide services in the area. For more details please see group task.   ', NULL, NULL, '2021-07-28 11:20:47', '2021-07-28 11:20:47'),
(40208, 1006, 30175, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40209, 3040, 30175, NULL, '2021-06-09 00:00:00.000', 'On Hold', 'Facility/ Ancillary network interest form submitted. Please see group task.    ', NULL, NULL, '2021-06-02 10:35:02', '2021-06-02 10:35:02'),
(40210, 3040, 30175, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: JENNIFER.PEREZ@cigna.com  Subject: Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello Jennifer,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Cigna Healthspring for our group under the below mentioned locations.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Waiting for your response.   Thank you  ', NULL, NULL, '2021-07-22 10:04:42', '2021-07-22 10:04:42'),
(40211, 11056, 30175, NULL, '2021-08-16 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hi Adil,  My apologies, I forwarded this to the correct representative. She should be reaching out by this week. ', NULL, NULL, '2021-08-09 09:00:08', '2021-08-09 09:00:08'),
(40212, 3040, 30175, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to: TXGQProviderRelations@healthspring.com  Subject: Re: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  Hello!  Hope you are doing well. As per conversation with Jennifer she requested to send an email to you. I wanted to know the enrollment status for the below mentioned group as I submitted the letter of interest form on 06/02/2021. Kindly review the chain of emails.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you', NULL, NULL, '2021-08-17 09:56:00', '2021-08-17 09:56:00'),
(40213, 10057, 30175, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email Sent To : TXMAContracting@cigna.com  Sub : Group Enrollment || Valley Med Urgent Care PLLC || Group || Cigna Healthspring ||  Hello,  Hope you are doing well. I wanted to know the enrollment updated status for the below mentioned group in Cigna Healthspring for our group Valley Med Urgent Care PLLC under the below mentioned locations.  Group Name	Valley Med Urgent Care PLLC (All three locations) Tax ID	81-5123542 Group NPI	1518404631 Primary Location	2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Location	101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166 Tertiary Location	800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-14 11:19:50', '2021-10-14 11:19:50'),
(40214, 10057, 30175, NULL, '2021-11-25 00:00:00.000', 'In Process', 'Email Sent To : TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello,  Could you please provide me with the updated status of my application?  Response is pending since 08/09/2021. Your earliest response will be much appreciated.  Thanks & Regards,', NULL, NULL, '2021-11-18 15:07:51', '2021-11-18 15:07:51'),
(40215, 10057, 30175, NULL, '2021-12-08 00:00:00.000', 'In Process', 'Email Received From : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Good afternoon,  Can you please send me the applications that you submitted?  Thank you.  Regards, Lilien Alvarado, MPA Provider Contracting Lead Analyst Cigna 2800 North Loop West,Ste 400', NULL, NULL, '2021-12-01 11:53:20', '2021-12-01 11:53:20'),
(40216, 10057, 30175, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Hello Lilien,  Thank you for reaching out to me. Kindly find the attached application for your reference.  Please let me know if you have any questions and revert back to me with the latest updates.  Thanks & Regards,', NULL, NULL, '2021-12-08 10:31:44', '2021-12-08 10:31:44'),
(40217, 10057, 30175, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Sent To : lilien.alvarado@gulfquest.net & TXGQProviderRelations@healthspring.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Greetings!  Hope this email finds you in good health. I\'m writing this email to check the current status of the below mentioned request.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please get back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-16 11:06:40', '2021-12-16 11:06:40'),
(40218, 10057, 30175, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Received From : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Please see attached communication from Renaissance.  Thank you.', NULL, NULL, '2021-12-22 10:14:31', '2021-12-22 10:14:31'),
(40219, 10057, 30175, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Sent To : joann.alanis@careallies.com  Sub : Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring  Thank you for reaching out. The attached letter was from Renaissance. We are inquiring about credentialing status for NUCC & IVUC with Cigna Healthspring.  Please get back to me once you get a chance. Have a great day!  Regards,', NULL, NULL, '2021-12-29 11:23:13', '2021-12-29 11:23:13'),
(40220, 19067, 30175, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   Good Morning JoAnn!  Hope you are doing really well.  I would like to know the enrollment status of the following Providers & Groups.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060   Kindly respond at your earliest convenience.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-05 11:23:26', '2022-01-05 11:23:26'),
(40221, 19067, 30175, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email received from: joann.alanis@careallies.com  Subject: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||   For Renaissance you are not contracted.', NULL, NULL, '2022-01-06 16:35:22', '2022-01-06 16:35:22'),
(40222, 20067, 30175, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Good afternoon, Hope this email finds you well. Could you please tell me for the Renaissance contract what procedure will be followed?  Thanks and regards, Syed Ahad. ', NULL, NULL, '2022-01-14 14:11:32', '2022-01-14 14:11:32'),
(40223, 20067, 30175, NULL, '2022-01-21 00:00:00.000', 'Not Eligible', 'Email received from: joann.alanis@careallies.com  Sub: Enrollment Query || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Providers & Groups || Cigna Healthspring ||  Hello!  The Renaissance-Eastside Board reviewed your Letter of Interest form a few months ago.  A letter was sent indicating that they were unable to extend a contract.  compliance. Copyright (c) 2022 CareAllies', NULL, NULL, '2022-01-14 14:46:34', '2022-01-14 14:46:34'),
(40224, 1006, 30176, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40225, 3040, 30176, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Triwest for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-31 14:57:44', '2021-05-31 14:57:44'),
(40226, 3040, 30176, NULL, '2021-06-25 00:00:00.000', 'On Hold', 'Group ancillary contract is already in process. For more details please see group task. ', NULL, NULL, '2021-06-18 10:15:11', '2021-06-18 10:15:11'),
(40227, 3040, 30176, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: jmonson@triwest.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Triwest ||  Hello Jess,   Can you please check and advise if the below mentioned group is in-network with Triwest or not. If not so can you please generate a contract for the below mentioned group. For your reference I attached the W9.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please let me know. Waiting for your response.  Thank you ', NULL, NULL, '2021-07-20 11:05:13', '2021-07-20 11:05:13'),
(40228, 3040, 30176, NULL, '2021-07-29 00:00:00.000', 'Approved', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-07-22 14:31:54', '2021-07-22 14:31:54'),
(40229, 1006, 30177, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:58', '2021-05-14 14:46:58'),
(40230, 3040, 30177, NULL, '2021-05-27 00:00:00.000', 'Not Eligible', 'Paramount does not cover Texas as it is an Ohio only plan, please find attached link for reference: https://www.paramounthealthcare.com/news/paramount-advantage-service-area-changes ', NULL, NULL, '2021-05-20 16:29:47', '2021-05-20 16:29:47'),
(40231, 1006, 30189, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(40232, 3040, 30189, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 13:58:24', '2021-05-31 13:58:24'),
(40233, 3040, 30189, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email sent to: txgqproviderrelations@healthspring.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-17 14:43:46', '2021-06-17 14:43:46'),
(40234, 3040, 30189, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: Chukwuma.Ezeokoli@careallies.com cc:	catherine.chang@careallies.com, shannon.luke@careallies.com,  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-05 16:48:46', '2021-07-05 16:48:46'),
(40235, 3040, 30189, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to: joann.alanis@careallies.com  Subject: Re: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Hello Alanis,   Hope you are doing well. Do you have any update regarding the enrollment for the below mentioned group and providers.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-07-26 12:43:49', '2021-07-26 12:43:49'),
(40236, 11056, 30189, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to :   joann.alanis@careallies.com   &   Chukwuma.Ezeokoli@careallies.com  Sub : Fwd: [External] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Renaissance Physicians ||  Good evening!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and practices. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider Details:  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 16:24:06', '2021-08-11 16:24:06'),
(40237, 3040, 30189, NULL, '2021-08-25 00:00:00.000', 'Not Eligible', 'Email rcvd from: JENNIFER.PEREZ@cigna.com  Subject: RE: [External] Re: Facility/Ancillary Network Interest Form || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group || Cigna Healthspring ||  08/03/2021 Normandy Urgent Care Center ATTN: Adil Abbas 779 Normandy Street, Suite 114 Houston, TX 77015 Dear Mr. Abbas, Thank you for your request to join the Renaissance Physician Organization/Eastside IPA, LLC. At the present time we do not have a network need in your particular specialty. As a result, we are not able to extend an invitation for participation at this time. We will however keep your request on file and reconsider in the event our network development needs change. If you have any questions, please feel free to call JoAnn Alanis at 832.553.3350. Sincerely, Julian Gonzalez, M.D. Chairman of The Board Eastside IPA, LLC', NULL, NULL, '2021-08-18 13:12:04', '2021-08-18 13:12:04'),
(40238, 1006, 30190, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40239, 3040, 30190, NULL, '2021-06-04 00:00:00.000', 'On Hold', 'Waiting for the enrollment in Molina healthcare.', NULL, NULL, '2021-05-28 14:25:38', '2021-05-28 14:25:38'),
(40240, 10057, 30190, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : Michele.Thomas-Martin@molinahealthcare.com & MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace  Good Afternoon,  Hope you are doing well. I\'m writing this email to check the enrollment and provider directory status for remaining providers under the below mentioned locations with Molina Marketplace.  Also, I\'m able to see the groups on provider directory, I already got the effective dates via help desk, please send me the group agreement or facility contract at the earliest   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226  Provider Name	NPI Fernandus, Limy	1972005189 Jacob, Jaya	1194336149 Thomas, Cini	1134777238 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 15:37:45', '2021-12-30 15:37:45'),
(40241, 19067, 30190, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Subject: Enrollment Status || NUCC - IVUC - LPMC || Molina Marketplace ||     Good Morning,     Thank you for your inquiry.  Please see the attached contracts for both TIN numbers.  Please see the updates below.     The only providers on the below list listed under TIN # 760612416 are Joseph, Vibitha and Rauf, Abdur.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the remaining providers.     The only providers not listed under TIN # 270796429 are Jacob Jaya and Jeny John.  Please submit a contract request form to MHTContractrequest@Molinahealthcare.com  to add the 2 providers under this TIN #.     Thank You,     Michele Thomas-Martin  Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042  1 972-200-2688 - Direct  www.MolinaHealthcare.com  Your Extended Family', NULL, NULL, '2022-01-05 17:21:24', '2022-01-05 17:21:24'),
(40242, 20067, 30190, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@Molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning, Hope you are doing well. Kindly see the attachment of the contract request form for Jaya Jacob & Jeny John Under TIN# 270796429  Thanks and Regards Syed Ahad', NULL, NULL, '2022-01-18 09:18:04', '2022-01-18 09:18:04'),
(40243, 20067, 30190, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace  Good Morning Syed,     Happy Thursday! – I hope all is well. I have received your requests. However, I noticed Provider Jaya Jacob 1194336149 already has a record created for TIN 27-0796429. Also, per Jeny John’s 1073019493 request, the service location is not listed per the form. Please fill in the service location & resubmit along with a current W9.', NULL, NULL, '2022-01-28 09:17:21', '2022-01-28 09:17:21'),
(40244, 20067, 30190, NULL, '2022-02-16 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good afternoon!  Thanks for the update. Kindly see the attachment for Jeny John 1073019493', NULL, NULL, '2022-02-09 15:28:17', '2022-02-09 15:28:17'),
(40245, 20067, 30190, NULL, '2022-02-28 00:00:00.000', 'In Process', 'Email sent to: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Happy Monday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-02-21 09:30:31', '2022-02-21 09:30:31'),
(40246, 20067, 30190, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon –     Happy Tuesday! Hope you are doing well. According to our record Ms. Thomas contracted you for all lobs. Please reach out to mhtxproviderservices@Molinahealthcare.com if you have any questions. They will be able to provide you with a roster for all par providers lines of business and effective dates. Thank you in advance have a wonderful day.  ', NULL, NULL, '2022-03-01 14:09:31', '2022-03-01 14:09:31'),
(40247, 20067, 30190, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@Molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Afternoon!  Happy Tuesday! Hope this email finds you in good health. I would like to know the current status of the below-mentioned providers  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Jeny John	1073019493 Molly Joseph	1396380077 Jaya Jacob	1194336149 Limy Fernandus	1972005189 Cini Thomas	1134777238 Brittany Brown	1275163537 Abdur Rauf	1497726202 Jeemol George	1497219067 Vibitha Joseph	1952931560 Ancy Kurian	1316558935  Thank you, Syed Ahad.', NULL, NULL, '2022-03-01 14:12:09', '2022-03-01 14:12:09'),
(40248, 20067, 30190, NULL, '2022-03-25 00:00:00.000', 'In Process', 'Email sent to: mhtxproviderservices@molinahealthcare.com  Sub: Re: Enrollment Status || NUCC - IVUC || Molina Marketplace   Good Morning!  Hope your day is going well. Kindly provide me the roster for the Par providers with effective dates.  Thank you, Syed.', NULL, NULL, '2022-03-18 10:48:41', '2022-03-18 10:48:41'),
(40249, 19067, 30190, NULL, '2022-04-06 00:00:00.000', 'Approved', 'Eff date: 07/15/2020. See the attached approval letter. ', NULL, NULL, '2022-03-30 15:58:46', '2022-03-30 15:58:46'),
(40250, 1006, 30191, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40251, 1019, 30191, NULL, '2021-06-15 00:00:00.000', 'Initiated', 'Sent the following email to colbee.snyder@primehealthservices.com SUB: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||   Greetings, Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-31 14:55:20', '2021-05-31 14:55:20'),
(40252, 3040, 30191, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email rcvd from:  colbee.snyder@primehealthservices.com  Subject: RE: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Thank you for your email. As of February 1st, 2020 I have been moved to a position outside of the credentialing department and will no longer be your point of contact. I have copied our general credentialing email.  Going forward, please forward all new providers adds and demographic changes to credentialing@primehealthservices.com and copy updates@primehealthservices.com.  Thank you!  Colbee Snyder Patient Advocacy Specialist', NULL, NULL, '2021-06-18 13:21:48', '2021-06-18 13:21:48'),
(40253, 3040, 30191, NULL, '2021-06-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-18 13:25:43', '2021-06-18 13:25:43'),
(40254, 3040, 30191, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com, updates@primehealthservices.com,  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Has there been any update?  Thank you  ', NULL, NULL, '2021-07-07 16:52:30', '2021-07-07 16:52:30'),
(40255, 3040, 30191, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Subject: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Hello,   Hope you are doing well. I was trying to reach out to know the enrollment status for the below mentioned group and providers in Prime Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  Please get back to me as soon as you can get a chance. Waiting for your response.   Thanks', NULL, NULL, '2021-07-22 11:56:27', '2021-07-22 11:56:27'),
(40256, 11056, 30191, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : credentialing@primehealthservices.com  Sub : Fwd: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health ||  Good Morning,  Please see below for the credentialing status for each provider.  The dates given are for credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will assist you with the effective dates.  There are two providers (highlighted) that need to be credentialed.  Please email a current CAQH Credentialing application or State Credentialing application for these providers.  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  - In the process of being credentialed.  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061 - Needs to be credentialed.     Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118 - In the process of being credentialed.   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509 - Last credentialed - 6-23-2020 - Not the effective date - For credentialing purposes only.   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537 - In the process of being credentialed.  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956 - In the process of being credentialed.   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490 - In the process of being credentialed.   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189 - In the process of being credentialed.   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202 - Last credentialed - 7-15-2020 - Not the effective date - For credentialing purposes only.  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868 - In the process of being credentialed.   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560 - In the process of being credentialed.   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238 - In the process of being credentialed.   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587 - In the process of being credentialed.   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616 - In the process of being credentialed.  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149 - In the process of being credentialed.  Provider 16:  Provider Name: Joseph, Molly Provider NPI# 1396380077 - In the process of being credentialed.  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493 - Needs to be Credentialed.', NULL, NULL, '2021-08-12 10:10:11', '2021-08-12 10:10:11'),
(40257, 3040, 30191, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: megan.wherry@primehealthservices.com  Subject: Re: Enrollment Status || Longpoint Medical Center || Group & Providers || Prime Health ||  Hello Megan,   Hope you are doing well. Can you please send the roster because I am trying to find out the providers on the Prime Health Services directory and it\'s not showing up.   Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-09-14 17:07:48', '2021-09-14 17:07:48'),
(40258, 12062, 30191, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Email sent to:megan.wherry@primehealthservices.com; colbee.snyder@primehealthservices.com; credentialing@primehealthservices.com; nucc@claimsmedinc.com; ivuc@claimsmedinc.com; Credentialing - Claims Med credentialing@claimsmedinc.com  Hi Wherry,  Hope you are doing well !   May I have any updated status for the enrollment application of below providers under the Prime Health Services Network?  I would be glad to have your response as soon as possible. The practice\'s and provider\'s details are as follows;   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441   Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060   Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067   Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061   Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118   Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509   Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537   Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956   Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490   Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189   Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202   Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868   Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560   Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238   Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587   Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616   Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149   Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077   Thanking You in advance.', NULL, NULL, '2021-09-17 12:31:13', '2021-09-17 12:31:13'),
(40259, 10057, 30191, NULL, '2021-11-04 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the updated status for the mentioned request. Please get back to me as soon as you get a chance.  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-10-28 15:16:05', '2021-10-28 15:16:05'),
(40260, 10057, 30191, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com>, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Hope this email finds you in good health. Can I get the latest update on all the below mentioned groups and providers enrollment status?  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Provider Name	NPI Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587 Thomas, Cini	1134777238 Kourouma , Odette Tiranke	1134525868 Rauf, Abdur	1497726202 Joseph, Molly	1396380077 John, Jeny	1073019493 Stephen, Ani	1588959118 Brown, Brittany	1275163537 Joseph, Vibitha	1952931560 George, Jeemol	1497219067 Jose, Julie	1447883061 Abraham, Glory	1194206490 Chennemkara, Mini Philip	1841755956 Piccione JR, James M	1356321509  Please respond back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-11-22 10:34:54', '2021-11-22 10:34:54'),
(40261, 10057, 30191, NULL, '2021-12-16 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com, updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello,  Can I get the latest updates on the below mentioned providers enrollment request under the TIN?  Please get back to me ASAP!  Thanks & Regards,', NULL, NULL, '2021-12-02 13:58:38', '2021-12-02 13:58:38'),
(40262, 10057, 30191, NULL, '2021-12-23 00:00:00.000', 'In Process', 'Email Received From : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Please see attached Credentialing Status Roster.  The dates given are for Credentialing purposes only and not the effective date.  Thank you for including the Updates Department in your email.  They will respond regarding the effective dates.  Thank you, Nancy', NULL, NULL, '2021-12-15 10:42:49', '2021-12-15 10:42:49'),
(40263, 10057, 30191, NULL, '2021-12-29 00:00:00.000', 'In Process', 'Email Sent To : credentialing@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello Nancy,  Thank you for your prompt response. I really appreciate your support. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-22 12:07:15', '2021-12-22 12:07:15'),
(40264, 10057, 30191, NULL, '2022-01-05 00:00:00.000', 'In Process', 'Email Received From : updates@primehealthservices.com  Sub : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Hello, all of these providers are in our system with both locations added, thanks!  Alyssa DeNure Data Integrity Associate', NULL, NULL, '2021-12-29 14:38:53', '2021-12-29 14:38:53'),
(40265, 20067, 30191, NULL, '2022-01-19 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub:  Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |   Good afternoon, Hope all is well with you. i would like to know the enrollment status of the below-mentioned providers.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI Jeny John	1073019493 Abdur Rauf	1497726202 Brittany Brown	1275163537 Vibitha Joseph	1952931560   Thanks and regards, Syed Ahad.', NULL, NULL, '2022-01-12 15:42:26', '2022-01-12 15:42:26'),
(40266, 20067, 30191, NULL, '2022-01-25 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com,  updates@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Evening! Hope you are doing great. Any updates on the below email?  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-18 17:54:00', '2022-01-18 17:54:00'),
(40267, 20067, 30191, NULL, '2022-02-04 00:00:00.000', 'In Process', 'Email sent to: credentialing@primehealthservices.com  Sub: Re: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning!  Hope this email finds you in good health. I would like to know the enrolment status of the below-mentioned providers and if any of them is enrolled kindly send me the welcome kit along with the effective date.  Group Name	Normandy Urgent Care Center Tax ID	270796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Jeny John	1407171077	779 Normandy St Ste 114 Houston, TX 77015-3441 Brittany Brown	1275163537	779 Normandy St Ste 114 Houston, TX 77015-3441 Vibitha Joseph	1952931560	779 Normandy St Ste 114 Houston, TX 77015-3441 Group	1407171077	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-28 11:45:00', '2022-01-28 11:45:00'),
(40268, 20067, 30191, NULL, '2022-03-09 00:00:00.000', 'In Process', 'Email received from: credentialing@primehealthservices.com  Sub: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |  Good Morning,  Providers Julie Josie and Jeny John have been credentialed as of 11-23-2021.  This date is for credentialing purposes only and not the effective date.  The Updates Department will respond regarding the effective date, Tax ID link and locations.  Thank you, Nancy', NULL, NULL, '2022-03-02 10:23:17', '2022-03-02 10:23:17'),
(40269, 20067, 30191, NULL, '2022-03-16 00:00:00.000', 'Approved', 'Email received from: patty.albright@primehealthservices.com  Sub: FW: [Fwd: ##RE-168872## : FW: [Fwd: ##RE-168872## : Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Prime Health |]]  Good Afternoon,  All of The providers indicated in your previous email have been added to both locations.  TIN  27-0796429  Julie Jose and Jeny John  Effective date: 11/19/2020     Thanks,', NULL, NULL, '2022-03-09 09:51:03', '2022-03-09 09:51:03'),
(40270, 1006, 30192, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40271, 3040, 30192, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Need to Enroll|| Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || CHRISTUS HEALTH PLAN||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Christus Health Plan for our group under the below locations. We have 02 different locations under the same tax ID.     Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-25 12:31:07', '2021-05-25 12:31:07'),
(40272, 3040, 30192, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Email sent to: CHP.networkdevelopment@christushealth.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Group & Providers || Christus Health Plan ||  Greetings,   Hope you are doing well. Please find the attached Prospective Provider Form along with the Letter of Intent for below mentioned providers to enroll in Christus Health Plan in our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-11 15:49:33', '2021-06-11 15:49:33'),
(40273, 11056, 30192, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : CHP.networkdevelopment@christushealth.org  Sub : Enroll Request Group & Providers || Normandy Urgent Care Center || Christus Health Plan ||  Greetings,  Hope you are doing well. I want to know enrollment status of the following groups and providers. Respond this as soon as possible.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Primary Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Secondary Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Providers: Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-29 13:00:29', '2021-06-29 13:00:29'),
(40274, 3040, 30192, NULL, '2021-07-26 00:00:00.000', 'On Hold', 'Ancillary contract request sent for the group. Please see group task. ', NULL, NULL, '2021-07-19 09:23:57', '2021-07-19 09:23:57'),
(40275, 3040, 30192, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Hello Hunter,   Hope you are doing well. Please find attached Ancillary service agreement along with the Facility Ancillary application for our group to participate in Christus Health Plan under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information please let me know. Waiting for your response.    Thanks ', NULL, NULL, '2021-07-28 11:39:30', '2021-07-28 11:39:30'),
(40276, 11056, 30192, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email sent to : Hunter Barrett   hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Sub  : ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. I just want to inquire about the enrollment status of the following groups for the ancillary contract. Please provide us with the latest updates soon.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226   If you need any additional information feel free to reach out to me. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-08-11 17:05:13', '2021-08-11 17:05:13'),
(40277, 3040, 30192, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email rcvd from: hunter.barrett@christushealth.org  Subject: RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Contract was sent to credentialing about 3 weeks ago to process. Will take about 6 months to fully process and receive effective date.  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-17 15:03:03', '2021-08-17 15:03:03'),
(40278, 3040, 30192, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Re: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN  Good evening!  Hope all is well. This is a follow up email to inquire about the enrollment status of the following groups for the ancillary contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Practice Name: Longpoint Medical Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:9504 LONG POINT RD STE E Houston , TX 77055-4226  If you need any additional information feel free to reach out to me. Waiting for your response.  Thanks', NULL, NULL, '2021-09-14 16:15:23', '2021-09-14 16:15:23');
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
(40279, 12062, 30192, NULL, '2021-09-29 00:00:00.000', 'In Process', ' Received below email under the group ancillary contract request; From :hunter.barrett@christushealth.org Subject :RE: ENROLLMENT REQUEST - NUCC - IVUC - CHRISTUS HEALTH PLAN Please reach out to our credentialing team in about 4 months for an update. You can reach out directly to them for updates on all of the contracts you are inquiring about. They are running around 6 months to process them so please give them adequate time to reach your file. Most of the contracts were sent to them around 1-2 months ago CHRISTUS.HP.Credentialing CHRISTUS.HP.Credentialing@christushealth.org  Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org  ', NULL, NULL, '2021-09-22 13:08:03', '2021-09-22 13:08:03'),
(40280, 10057, 30192, NULL, '2021-10-25 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Evening,  Hope you are doing well. I want to know the enrollment status of the following groups and providers. Please get back to me as soon as you get the time.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	779 Normandy St Ste 114 Houston , TX 77015-3441  Group Name	Imperial Valley Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Practice Address	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	27-0796429 Group NPI	1407171077 Practice Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI John, Jeny	1073019493 Jose, Julie	1447883061 George, Jeemol	1497219067 Brown, Brittany	1275163537 Rauf, Abdur	1497726202 Kourouma , Odette Tiranke	1134525868 Thomas, Cini	1134777238 Joseph, Vibitha	1952931560 Stephen, Ani	1588959118 Piccione JR, James M	1356321509 Chennemkara, Mini Philip	1841755956 Abraham, Glory	1194206490 Fernandus, Limy	1972005189 PAUL, SIGI	1033623616 Jacob, Jaya	1194336149 Abraham, Jeena	1467901587  Your earliest response will be highly appreciated.  Thanks & Regards,', NULL, NULL, '2021-10-18 16:30:21', '2021-10-18 16:30:21'),
(40281, 10057, 30192, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can someone please get back to me with an update on our applications for providers, I have attached our group roster, also if there should be any concerned person who will help me out with my queries rather than sending everyone an email for an update, and also our applications are stuck now for way too much time.  If they are completed please provide me with the effective dates and Copy of there Welcome Letters / Contract.  Regards, Alex', NULL, NULL, '2021-11-10 17:42:55', '2021-11-10 17:42:55'),
(40282, 10057, 30192, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good afternoon,  All 3 facilities are awaiting the November Credentials Committee Meeting that is scheduled for November 16, 2021. If you have not received Welcome Letters by December 1st, then please send another email to CHRISTUS.HP.Credentialing@christushealth.org requesting the letters. Have a blessed day!  Thank you,  Tommishia Offord, CPCS Credentialing Supervisor CHRISTUS Health (o) 469.282.3158 (f) 210.766.9254', NULL, NULL, '2021-11-10 17:46:05', '2021-11-10 17:46:05'),
(40283, 10057, 30192, NULL, '2021-12-02 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Good Afternoon,  Hope you are doing well. Can I have the latest update on the below mentioned request. Also welcome letters?  Looking forward to your kind response. Have a great day!   Thanks & Regards,', NULL, NULL, '2021-11-18 13:41:12', '2021-11-18 13:41:12'),
(40284, 10057, 30192, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : Need Credentialing Update - URGENT  Hello,  Can I get the update on the below mentioned request, also I have not yet received any welcome letters yet.  Kindly revert back to me as soon as possible.  Thanks & Regards,', NULL, NULL, '2021-12-01 10:44:23', '2021-12-01 10:44:23'),
(40285, 10057, 30192, NULL, '2021-12-21 00:00:00.000', 'In Process', 'Email Received From : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Good Morning  Normandy Urgent Care Center  - has been processed effective contract date 01/01/2022  Longpoint Medical Center – facility has been processed effective contract date 01/01/2022  Imperial Valley - facility has been processed effective contract date 01/01/2022  Credentialing Verification Unit CHRISTUS Health Plan - US Family Health Plan 919 Hidden Ridge Irving, TX 75038 Phone: (469)-282-0368 Fax: 210-766-8857', NULL, NULL, '2021-12-14 09:51:13', '2021-12-14 09:51:13'),
(40286, 10057, 30192, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Thank you for the update. Could you please provide us with the facility agreement or contract along with the update for the providers credentialing status as well.  Your earliest response would be greatly appreciated.  Regards, Steve Albert', NULL, NULL, '2021-12-20 13:38:37', '2021-12-20 13:38:37'),
(40287, 10057, 30192, NULL, '2022-01-04 00:00:00.000', 'In Process', 'Email Sent To : CHRISTUS.HP.Credentialing@christushealth.org  Sub : ENROLLMENT REQUEST - NUCC - IVUC - LPMC - CHRISTUS HEALTH PLAN  Greetings!  Hope you are doing great. I\'m writing this email to get the update on my below request. Please get back to me as soon as possible!  Regards,', NULL, NULL, '2021-12-28 11:56:12', '2021-12-28 11:56:12'),
(40288, 19067, 30192, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: CHRISTUS.HP.Credentialing@christushealth.org, hunter.barrett@christushealth.org, CHP.networkdevelopment@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Christus Health Plan.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:26:38', '2022-01-04 17:26:38'),
(40289, 19067, 30192, NULL, '2022-01-12 00:00:00.000', 'In Process', 'Email received from: Sonia.Gonzales@christushealth.org  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||     Good Morning All,     Thank you for the request below, I do show contract for USFHP was signed and executed.   Information was sent over to get configuration of contract rates entered.       Once we have this process is completed we can have this sent to Credentialing to get group loaded with effective date.  When I get further updates will pass along!     Please remove Hunter Barrette from communications, unfortunately he is no longer with us, I am covering in the interim.       Thanks and appreciate your patience,     Respectfully,     Sonia D. Gonzales  CHRISTUS Health Plan – Physician Relations Consultant II/ Contracting  505-569-4856  sonia.gonzales@christushealth.org', NULL, NULL, '2022-01-05 11:35:49', '2022-01-05 11:35:49'),
(40290, 20067, 30192, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good Afternoon, Hope this email finds you in good health. Any update on the previous request?  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 13:32:07', '2022-01-14 13:32:07'),
(40291, 20067, 30192, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: Sonia.Gonzales@christushealth.org  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Christus Health Plan ||  Good afternoon! Hope you are doing well. I haven\'t heard from your side, Kindly respond to the previous mail. If the process is complete, kindly send me the contract letter along with the effective date.  Thanks and Regards, Syed Ahad  ', NULL, NULL, '2022-01-21 16:50:30', '2022-01-21 16:50:30'),
(40292, 20067, 30192, NULL, '2022-02-01 00:00:00.000', 'Approved', 'Received the Ancillary contract from Christus Health Plan  Effective Date: 01/01/2022 Expiration Date: 12/31/9999', NULL, NULL, '2022-01-25 17:39:15', '2022-01-25 17:39:15'),
(40293, 1006, 30193, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40294, 3040, 30193, NULL, '2021-06-04 00:00:00.000', 'In Process', 'Email sent to: providerservices@memorialhermann.org  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Memorial Hermann for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-28 13:23:46', '2021-05-28 13:23:46'),
(40295, 3040, 30193, NULL, '2021-06-23 00:00:00.000', 'On Hold', 'Group ancillary contract request sent to Memorial Hermann. For more details please see group task.  ', NULL, NULL, '2021-06-16 16:40:41', '2021-06-16 16:40:41'),
(40296, 3040, 30193, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to: enterprise.credentialing@memorialhermann.org  Subject: Re: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Hello,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned group in Memorial Hermann for our group under the below locations.    Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Please get back to me as soon as you can get a chance. Waiting for your response.   Thank you ', NULL, NULL, '2021-07-20 10:52:23', '2021-07-20 10:52:23'),
(40297, 11056, 30193, NULL, '2021-08-20 00:00:00.000', 'In Process', 'Email sent to : ProviderServices@memorialhermann.org  &  MHHPContracting@memorialhermann.org  Sub : Fwd: [EXTERNAL] Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Memorial Hermann ||  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned group under the below locations for Ancillary contract in Memorial Hermann.  Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-08-12 16:15:51', '2021-08-12 16:15:51'),
(40298, 3040, 30193, NULL, '2021-09-03 00:00:00.000', 'Approved', 'Group has an ancillary contract no need to add individual providers. Please see group task for more details. ', NULL, NULL, '2021-08-27 10:00:36', '2021-08-27 10:00:36'),
(40299, 1006, 30195, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40300, 1006, 30195, NULL, '2021-05-28 00:00:00.000', 'Initiated', 'Submitted group enrollment request via Wellcare\'s online form, attached for reference in group task. ', NULL, NULL, '2021-05-20 20:59:17', '2021-05-20 20:59:17'),
(40301, 3040, 30195, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Waiting for the group enrollment. For more details please see group task.', NULL, NULL, '2021-06-09 10:44:37', '2021-06-09 10:44:37'),
(40302, 3040, 30195, NULL, '2021-07-27 00:00:00.000', 'In Process', 'I spoke with Harvey D Wellcare representative and he advised me that processing time will take 60 business days. After reviewing the application the provider rep will contact you.   Ref: 544023676', NULL, NULL, '2021-07-20 10:36:18', '2021-07-20 10:36:18'),
(40303, 11056, 30195, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good afternoon!  Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061     Provider 3:    Provider Name: Stephen, Ani  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537     Provider 6:    Provider Name: Chennemkara, Mini Philip  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490     Provider 8:    Provider Name: Fernandus, Limy  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560     Provider 12:    Provider Name: Thomas, Cini  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587     Provider 14:    Provider Name: PAUL, SIGI   Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!  Have a great week ahead!', NULL, NULL, '2021-08-11 13:51:04', '2021-08-11 13:51:04'),
(40304, 3040, 30195, NULL, '2021-09-14 00:00:00.000', 'In Process', 'Email sent to: ProspectiveProviderTX@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned group and providers in Wellcare for our group under the below locations.       Practice Details:  Practice Name: Normandy Urgent Care Center  Practice Tax ID# 27-0796429  Practice NPI# 1407171077  Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441     Practice Name: Imperial Valley Urgent Care Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060     Practice Name: Longpoint Medical Center  Practice Tax ID#  27-0796429  Practice NPI# 1407171077  Practice Address: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 1:  Provider Name: George, Jeemol  Provider NPI# 1497219067  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 2:    Provider Name: Jose, Julie  Provider NPI# 1447883061  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 3:    Provider Name: Stephen, Ani (All three locations)  Provider NPI# 1588959118     Provider 4:    Provider Name: Piccione JR, James M (All three locations)  Provider NPI# 1356321509     Provider 5:    Provider Name: Brown, Brittany  Provider NPI# 1275163537  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 6:    Provider Name: Chennemkara, Mini Philip (All three locations)  Provider NPI# 1841755956     Provider 7:    Provider Name: Abraham, Glory  Provider NPI# 1194206490  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 8:    Provider Name: Fernandus, Limy (All three locations)  Provider NPI# 1972005189     Provider 9:    Provider Name: Rauf, Abdur  Provider NPI# 1497726202  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 10:    Provider Name: Kourouma , Odette Tiranke  Provider NPI# 1134525868  Additional Location: 16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 11:    Provider Name: Joseph, Vibitha  Provider NPI# 1952931560  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 12:    Provider Name: Thomas, Cini (All three locations)  Provider NPI# 1134777238     Provider 13:    Provider Name: Abraham, Jeena  Provider NPI# 1467901587  Additional Location: 779 Normandy St Ste 114  Houston , TX 77015-3441  Additional Location: 9504 LONG POINT RD STE E  Houston , TX 77055-4226     Provider 14:    Provider Name: PAUL, SIGI (All three locations)  Provider NPI# 1033623616     Provider 15:    Provider Name: Jacob, Jaya (All three locations)  Provider NPI# 1194336149    Provider 16:    Provider Name: Joseph, Molly  (All three locations) Provider NPI# 1396380077    Provider 17:    Provider Name: John, Jeny  (All three locations) Provider NPI# 1073019493    If you need any additional information please feel free to call or email me. Waiting to hear from you soon.      Thank you!', NULL, NULL, '2021-09-07 16:28:11', '2021-09-07 16:28:11'),
(40305, 10057, 30195, NULL, '2021-10-26 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I want to follow-up for the mentioned providers and locations credentialing status?  Please get back to me as soon as you get a chance. Looking forward to your kind response.  Thanks & Regards,', NULL, NULL, '2021-10-19 11:45:43', '2021-10-19 11:45:43'),
(40306, 10057, 30195, NULL, '2021-11-29 00:00:00.000', 'In Process', 'Email Sent To : prospectiveprovidertx@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Morning,  Can you please send us the copy of their Welcome Letters/ Contracts to us at your earliest convenience.  Regards, Alex Garrett', NULL, NULL, '2021-11-22 14:12:29', '2021-11-22 14:12:29'),
(40307, 10057, 30195, NULL, '2021-12-09 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Good Afternoon,  Hope this email finds you well. I\'m writing this email to check the latest update on the below mentioned request?  Looking forward to hearing from you soon.  Thanks & Regards,', NULL, NULL, '2021-12-02 15:08:01', '2021-12-02 15:08:01'),
(40308, 10057, 30195, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : ProspectiveProviderTX@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Hello,  This inbox is for contract change request only. If you need account specific information, please contact your Provider Relations Account Manager.   Sincerely,  Network Management– Texas', NULL, NULL, '2021-12-09 13:18:20', '2021-12-09 13:18:20'),
(40309, 10057, 30195, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : ProspectiveProviderTX@wellcare.com AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Thank you for reaching out. Could you please provide me with the actual email address along with the contact number of our AM?  So I can directly reach out to them. I truly appreciate your support. Have a great day!  Regards,', NULL, NULL, '2021-12-17 14:07:42', '2021-12-17 14:07:42'),
(40310, 10057, 30195, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email Received From : AM.Houston@superiorhealthplan.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Please send email for WellCare status update to SM_TXNetDevProviderLoad@wellcare.com.  Sincerely,  Barbara McDonald', NULL, NULL, '2021-12-23 11:18:28', '2021-12-23 11:18:28'),
(40311, 10057, 30195, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email Sent To : sm_txnetdevproviderload@wellcare.com  Sub : ENROLLMENT STATUS QUERRY - NUCC - IVUC - LPMC - Wellcare  Greetings!  Hope this email finds you well. I\'m writing this email to get the enrollment status on the below mentioned group and providers under TIN\'s with wellcare.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060  Group Name	Longpoint Medical Center Tax ID	76-0612416 Group NPI	1770763815 Practice Location	9504 LONG POINT RD STE E, Houston, TX 77055-4226 Provider Name	NPI  Limy  Fernandus 1972005189 Sigi Paul	1033623616 Jaya  Jacob	1194336149 Jeena  Abraham	1467901587 Cini  Thomas	1134777238 Odette Tiranke  Kourouma	1134525868 Abdur  Rauf	1497726202 Molly  Joseph	1396380077 Jeny John	1073019493 Ani Stephen	1588959118 Brittany Brown	1275163537 Vibitha Joseph	1952931560 Jeemol George	1497219067 Julie Jose	1447883061 Glory Abraham 1194206490 Mini Philip Chennemkara 1841755956 James Piccione JR	1356321509  Once you get a chance please get back to me. Have a great weekend ahead!  Regards,', NULL, NULL, '2021-12-30 13:51:30', '2021-12-30 13:51:30'),
(40312, 20067, 30195, NULL, '2022-01-13 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Subject: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare   Hello,  Hope you are doing great. I would like to know the enrollment status of the below-mentioned providers under these locations, and if any of the provider is enrolled kindly send me the welcome letter.  Group NPI	1407171077 Primary Location	779 Normandy St Ste 114 Houston, TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston, TX 77060 Provider Name	NPI Glory Abraham	1194206490 Jeena Abraham	1467901587 Brittany Brown	1275163537 Mini Chennemkara	1841755956 Limy Fernandus	1972005189 Jeemol George	1497219067 Jaya Jacob	1194336149 Jeny John	1073019493 Julie Jose	1447883061 Molly Joseph	1396380077 Vibitha Joseph	1952931560 Odette Kourouma	1134525868 SIGI PAUL	1033623616 James Piccione JR	1356321509 Abdur Rauf	1497726202 Ani Stephen	1588959118 Cini Thomas	1134777238  Thanks and Regards, Syed Ahad. ', NULL, NULL, '2022-01-06 12:27:19', '2022-01-06 12:27:19'),
(40313, 20067, 30195, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: ashley.stevens@wellcare.com, SM_TXNetDevProviderLoad@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Good afternoon!  Hope you are doing well. Any update on the previous request? Your Early response will be highly appreciated  Thanks and Regards, Syed Ahad', NULL, NULL, '2022-01-14 16:47:01', '2022-01-14 16:47:01'),
(40314, 20067, 30195, NULL, '2022-01-27 00:00:00.000', 'Approved', 'Received the following email from: ashley.stevens@wellcare.com  Sub: Re: ENROLLMENT STATUS QUERRY - NUCC - IVUC - Wellcare  Please see welcome letter attached for roster of par providers.  Effective Date: 05/03/2021 Attached is the group roster and welcome letter for the provider ', NULL, NULL, '2022-01-20 16:49:30', '2022-01-20 16:49:30'),
(40315, 1006, 30196, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-14 14:46:59', '2021-05-14 14:46:59'),
(40316, 3040, 30196, NULL, '2021-06-03 00:00:00.000', 'In Process', 'Email sent to: Dmarley@ghn-mci.com  Subject: Enroll Group & Providers || Normandy Urgent Care Center & Imperial Valley Urgent Care Center || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned group and providers in Galaxy Health for our group under the below locations.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-05-27 12:53:29', '2021-05-27 12:53:29'),
(40317, 3040, 30196, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Email rcvd from: dmarley@ghn-mci.com  Subject: Normandy Urgent Care  Hello Adil,  I am writing you in response to an e-mail that you sent requesting to add providers to Normandy Urgent Care and Imperial Valley Urgent Care.  After review, I do show a contract for Normandy Urgent Care and if that group wishes your company, Claims Med Inc to be able to add providers etc. then you will need to return written notice signed by an authorized signatory of the group stating that your company Claims Med Inc is authorized to add new providers, etc. to their agreement. We will also need full credentialing for all new providers. This information can be faxed to 1-800-645-0154 for processing.  I do not show an agreement for Imperial Valley Urgent Care. If this group would like a contract, please let me know, however, can you please confirm that these two different groups are using the same tin? If this is to be the case the providers will have to submit written notice for one group affiliation to take precedence over the other.  Please do not hesitate to contact me with any question or concerns I am happy to help.  Thanks,  Daniel M. Contract Specialist Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-06-15 14:38:17', '2021-06-15 14:38:17'),
(40318, 3040, 30196, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: longpointmedcenter9504@yahoo.com  Subject: Normandy Urgent Care  Greetings,  Hope you are doing well. Please find attached Letter of intent to enroll the providers in Galaxy Health. They requested the authorized person\'s signature on the letterhead in which it stated we need to enroll the providers individually with Galaxy Health. For your reference please review the above email.   Kindly sign it and send it back to me so we can start the credentialing process.   Thank you ', NULL, NULL, '2021-07-05 10:04:28', '2021-07-05 10:04:28'),
(40319, 3040, 30196, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com  Subject: Normandy Urgent Care   Hello Daniel,   Hope you are doing well. As per our phone conversation please find below the list of the providers and see which providers are participating with Galaxy Health and need the effective date. For the remaining providers please send me the credentialing application form so I can fill it out and send it through fax.  Also advise that below mentioned addresses are updated in the contract.   Practice Details: Practice Name: Normandy Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address: 779 Normandy St Ste 114  Houston , TX 77015-3441  Practice Name: Imperial Valley Urgent Care Center Practice Tax ID# 27-0796429 Practice NPI# 1407171077 Practice Address:16272 IMPERIAL VALLEY DR STE K,  Houston , TX 77060  Provider 1: Provider Name: George, Jeemol Provider NPI# 1497219067  Provider 2:   Provider Name: Jose, Julie Provider NPI# 1447883061  Provider 3:   Provider Name: Stephen, Ani Provider NPI# 1588959118  Provider 4:   Provider Name: Piccione JR, James M Provider NPI# 1356321509  Provider 5:   Provider Name: Brown, Brittany Provider NPI# 1275163537  Provider 6:   Provider Name: Chennemkara, Mini Philip Provider NPI# 1841755956  Provider 7:   Provider Name: Abraham, Glory Provider NPI# 1194206490  Provider 8:   Provider Name: Fernandus, Limy Provider NPI# 1972005189  Provider 9:   Provider Name: Rauf, Abdur Provider NPI# 1497726202  Provider 10:   Provider Name: Kourouma , Odette Tiranke Provider NPI# 1134525868  Provider 11:   Provider Name: Joseph, Vibitha Provider NPI# 1952931560  Provider 12:   Provider Name: Thomas, Cini Provider NPI# 1134777238  Provider 13:   Provider Name: Abraham, Jeena Provider NPI# 1467901587  Provider 14:   Provider Name: PAUL, SIGI  Provider NPI# 1033623616  Provider 15:   Provider Name: Jacob, Jaya Provider NPI# 1194336149  Provider 16:   Provider Name: Joseph, Molly Provider NPI# 1396380077  Provider 17:   Provider Name: John, Jeny Provider NPI# 1073019493  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-07-22 10:01:23', '2021-07-22 10:01:23'),
(40320, 11056, 30196, NULL, '2021-08-19 00:00:00.000', 'In Process', 'Email received from : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Adil,  To confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health. Providers under this TIN participate with a group affiliation with Normandy Urgent Care Center.  I already e-mailed you the forms you requested for credentialing. In regards to the listed providers please see the below:  Dr. Abdur Rauf – effective 7-31-15 Odette Kourouma FNP – effective 77015  I show the two providers from your list below as participating under Normandy Urgent Care Center. I do not show any other providers from the roster you sent as participating.  Imperial Valley Urgent Care does not have a contract with Galaxy Health.  Thanks, Daniel M. Contract Specialist  Galaxy Health Network (P) 800-975-3322 X 1124 (F) 1-800-645-0154', NULL, NULL, '2021-08-12 11:35:43', '2021-08-12 11:35:43'),
(40321, 10057, 30196, NULL, '2021-10-15 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Hello Daniel,  Greetings for the day!  I\'m writing this email to check the updated status about our credentialing request for Normandy Urgent Care and Imperial Valley Urgent Care.  Let me know if there are any documents needed from our side. Also we have already forwarded your requested forms via fax 800-645-0154.on 07/12/2021.  Have a great day ahead.  Thanks & Regards,', NULL, NULL, '2021-10-08 10:42:48', '2021-10-08 10:42:48'),
(40322, 10057, 30196, NULL, '2021-11-30 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Dear Sir,  After review, I have not been able to locate a written notice signed by an authorized Signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is authorized to represent the group, or make changes on their behalf. If you would please fax that to 1-800-645-0154.  Further, I show a roster of Physicians for Normandy Urgent Care as having been received, however, I do not show either the authorization letter above or any  credentialing or supporting document for the providers who are to be added as having been received back. I am reattaching the forms that were sent previously here. They can be faxed back to 1-800-645-0154 along with the letter authorizing Claims Med Inc. to represent Normandy Urgent Care group.  Further, to confirm Imperial Valley Urgent Care does not have a contract with Galaxy Health to which providers can be added. If they would like to consider a contract for review, please let me know.', NULL, NULL, '2021-11-23 17:24:24', '2021-11-23 17:24:24'),
(40323, 10057, 30196, NULL, '2021-12-10 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Greetings!  I have forwarded you the following provider(s) details via fax 1-800-645-0154 just now, please check and let me know what else needed, also guide me how we can make a contract for Imperial Valley Urgent Care.  Group Name	Normandy Urgent Care Center Tax ID	81-5123542 Group NPI	1518404631 Primary Location	779 Normandy St Ste 114 Houston , TX 77015-3441 Secondary Location	16272 IMPERIAL VALLEY DR STE K, Houston , TX 77060 Tertiary Location	9504 LONG POINT RD STE E Houston , TX 77055-4226  Provider Name	NPI Abraham, Jeena	1467901587 Abraham, Glory	1194206490 Brown, Brittany	1275163537 Chennemkara, Mini Philip	1841755956 Fernandus, Limy	1972005189 George, Jeemol	1497219067 Jacob, Jaya	1194336149 John, Jeny	1073019493 Jose, Julie	1447883061 Joseph, Molly	1396380077 Joseph, Vibitha	1952931560 Kourouma , Odette Tiranke	1134525868 PAUL, SIGI	1033623616 Piccione JR, James M	1356321509 Rauf, Abdur	1497726202 Stephen, Ani	1588959118 Thomas, Cini	1134777238  Looking forward to hearing from you.  Thanks & Regards,', NULL, NULL, '2021-12-03 15:16:01', '2021-12-03 15:16:01'),
(40324, 10057, 30196, NULL, '2021-12-17 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Sir,  I will review, however, did you also include a written notice signed by an authorized signatory of Normandy Urgent Care stating that your company Claims Med Inc. is representing them and is authorized to make changes, etc. on the groups behalf?', NULL, NULL, '2021-12-10 13:12:16', '2021-12-10 13:12:16'),
(40325, 10057, 30196, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email Sent To : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  Good Afternoon,  Hope this email finds you in good health. I want to set up a short telephonic meeting with you, so please let me know the day/date and time.  Our practice manager from NORMANDY URGENT CARE wants to discuss to resolve this issue.  Please get back to me as soon as you get a chance. Have a great day!  Thanks & Regards,', NULL, NULL, '2021-12-17 10:48:22', '2021-12-17 10:48:22'),
(40326, 10057, 30196, NULL, '2021-12-31 00:00:00.000', 'In Process', 'Email Received From : dmarley@ghn-mci.com  Sub : Fwd: Normandy Urgent Care  It was great speaking with you today Sir, please see the below.  Sir,  I am writing you in response to several e-mails you have sent regarding various urgent cares.  After review, I show the following:  We have received partial credentialing for providers for Normandy Urgent Care, however, I show the physician group for Normandy Urgent Care is under a different TIN then the one you provided on 10-14-2021 and I don’t show having received anything from the Normandy Urgent Care Group in writing signed by an authorized signatory of Normandy Urgent Care stating that your company, Claims Med Inc. is representing them and is authorized to make changes etc. on their behalf.  If you could please fax that authorization and include the correct TIN to 1-800-645-0154 along with the supporting documents, and please confirm that all credentialing documents were physically signed by the providers and not electronically signed, I will forward that for processing for the providers.  In regards to the e-mail you sent regarding Valley Med Urgent Care which has the correct TIN for Valley Med (which is the same TIN you submitted for Normandy Urgent Care but I show Normandy under a different TIN),  I show a facility agreement for Valley Med Urgent Care. If the physicians bill under the facilities Tax Id Number, and the facility has an agreement then the physicians do not need to be added/listed.', NULL, NULL, '2021-12-23 10:40:11', '2021-12-23 10:40:11'),
(40327, 19067, 30196, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Subject: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Hello!  You are having a productive day.  I would like to know the enrollment status of the following Providers and Group with Galaxy Health.   Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Eagerly waiting for your response.   Thanks & Regards, Hammad Ahmed.', NULL, NULL, '2022-01-04 17:41:46', '2022-01-04 17:41:46'),
(40328, 20067, 30196, NULL, '2022-01-21 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Afternoon! Hope this email finds you in good health.Any update on the below mentioned request?  Your Early response will be highly appreciated Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-01-14 15:29:14', '2022-01-14 15:29:14'),
(40329, 20067, 30196, NULL, '2022-01-31 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com  Sub: Re: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good Morning!   Hope you had a great weekend. Kindly update me on the previous request which was sent on 01/04/2022.  Thanks & Regards, Syed Ahad. ', NULL, NULL, '2022-01-24 10:05:41', '2022-01-24 10:05:41'),
(40330, 20067, 30196, NULL, '2022-02-09 00:00:00.000', 'In Process', 'Email sent to: dmarley@ghn-mci.com, kavalos@ghn-mci.com,   Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Good afternoon!  This is my SECOND REMINDER on the previous request. Kindly respond promptly  Thanks & Regards, Syed Ahad.', NULL, NULL, '2022-02-02 16:05:48', '2022-02-02 16:05:48'),
(40331, 20067, 30196, NULL, '2022-03-08 00:00:00.000', 'In Process', 'Email sent to: kavalos@ghn-mci.com, dmarley@ghn-mci.com, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||   Good Afternoon!  Hope this email finds you well. I would like to know the enrollment status of the group and providers below.  Group Name	Normandy Urgent Care Center Tax ID	27-0796429 Group NPI	1407171077 Provider Name	NPI	Location Jeny John	1073019493	779 Normandy St STE 114, Houston, TX 77015-3441 Jeny John	1073019493	16272 Imperial Valley DR STE K, Houston, TX 77060 Molly Joseph	1396380077	779 Normandy St STE 114, Houston, TX 77015-3441 Molly Joseph	1396380077	16272 Imperial Valley DR STE K, Houston, TX 77060 Cini Thomas	1134777238	779 Normandy St STE 114, Houston, TX 77015-3441 Cini Thomas	1134777238	16272 Imperial Valley DR STE K, Houston, TX 77060 Ani Stephen	1588959118	779 Normandy St STE 114, Houston, TX 77015-3441 Ani Stephen	1588959118	16272 Imperial Valley DR STE K, Houston, TX 77060 Abdur Rauf	1497726202	779 Normandy St STE 114, Houston, TX 77015-3441 Abdur Rauf	1497726202	16272 Imperial Valley DR STE K, Houston, TX 77060 James Piccione JR	1356321509	779 Normandy St STE 114, Houston, TX 77015-3441 James Piccione JR	1356321509	16272 Imperial Valley DR STE K, Houston, TX 77060 Sigi Paul	1033623616	779 Normandy St STE 114, Houston, TX 77015-3441 Sigi Paul	1033623616	16272 Imperial Valley DR STE K, Houston, TX 77060 Odette Kourouma	1134525868	779 Normandy St STE 114, Houston, TX 77015-3441 Odette Kourouma	1134525868	16272 Imperial Valley DR STE K, Houston, TX 77060 Vibitha Joseph	1952931560	779 Normandy St STE 114, Houston, TX 77015-3441 Vibitha Joseph	1952931560	16272 Imperial Valley DR STE K, Houston, TX 77060 Julie Jose	1447883061	779 Normandy St STE 114, Houston, TX 77015-3441 Julie Jose	1447883061	16272 Imperial Valley DR STE K, Houston, TX 77060 Jaya Jacob	1194336149	779 Normandy St STE 114, Houston, TX 77015-3441 Jaya Jacob	1194336149	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeemol George	1497219067	779 Normandy St STE 114, Houston, TX 77015-3441 Jeemol George	1497219067	16272 Imperial Valley DR STE K, Houston, TX 77060 Limy Fernandus	1972005189	779 Normandy St STE 114, Houston, TX 77015-3441 Limy Fernandus	1972005189	16272 Imperial Valley DR STE K, Houston, TX 77060 Brittany Brown	1275163537	779 Normandy St STE 114, Houston, TX 77015-3441 Brittany Brown	1275163537	16272 Imperial Valley DR STE K, Houston, TX 77060 Jeena Abraham	1467901587	779 Normandy St STE 114, Houston, TX 77015-3441 Jeena Abraham	1467901587	16272 Imperial Valley DR STE K, Houston, TX 77060 Mini Chennemkara	1841755956	779 Normandy St STE 114, Houston, TX 77015-3441 Mini Chennemkara	1841755956	16272 Imperial Valley DR STE K, Houston, TX 77060 Glory Abraham	1194206490	779 Normandy St STE 114, Houston, TX 77015-3441 Glory Abraham	1194206490	16272 Imperial Valley DR STE K, Houston, TX 77060  Thank you,', NULL, NULL, '2022-03-01 15:08:38', '2022-03-01 15:08:38'),
(40332, 20067, 30196, NULL, '2022-03-24 00:00:00.000', 'In Process', 'Email sent to: Karen Avalos, Daniel Marley, providers@ghn-mci.com, contracting@ghn-mci.com  Sub: Enrollment Query || NUCC & IVUC || Providers & Group || Galaxy Health ||  Hello!  Kindly update me on the request which was sent on 03/01/2022.  Thank you, Syed ', NULL, NULL, '2022-03-17 17:58:18', '2022-03-17 17:58:18');
