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
(35853, 1006, 28356, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ MHHP Contracting MHHPContracting@memorialhermann.org  MH Health Provider Relations ProviderServices@memorialhermann.org:  Sub; Network Participation Form - CBUC/GWMC - Memorial Hermann  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers. Their information is as follows:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\'', NULL, NULL, '2021-07-13 17:22:43', '2021-07-13 17:22:43'),
(35854, 1006, 28356, NULL, '2021-08-02 00:00:00.000', 'In Process', 'We received the following response from MHHP Contracting MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"We are in receipt of Coastal Bend Urgent Care’s request to become a participating provider with Memorial Hermann Health Plans and need additional information to proceed with your request.  Please provide the following information:  List of services provided ·         Do you provide Virtual Health Services?  Current service area and/or list of locations List of all employed/contracted providers (if applicable) including NPs and PAs (please include individual NPIs) What age population is served? Please list 0-2 years of age; 2-18 years of age; 18+ years Where do you have privileges? Please list all Hospitals, Ambulatory Surgery Centers, etc. Link to website Current W-9 Current quality and outcomes data Any additional information you would like presented to the Network Access and Adequacy Committee   Your participation request will be presented at the next NAAC meeting following receipt of the additional information.\"  Responded to the queries.', NULL, NULL, '2021-07-26 13:19:59', '2021-07-26 13:19:59'),
(35855, 1006, 28356, NULL, '2021-08-05 00:00:00.000', 'Not Eligible', 'We received  the following denial notification from MHHPContracting@memorialhermann.org:  Sub: Memorial Hermann Health Plan Request to Participate  \"At this time, the cities listed below are out of our network area, and we do not contract out of network at this time. I am withdrawing your application for participation. If something changes in the near future, we will let you know. Please let me know if you have any questions.  Thank you. Camilla Paige\"', NULL, NULL, '2021-07-29 13:34:25', '2021-07-29 13:34:25'),
(35856, 1006, 28358, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35857, 3040, 28358, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:31:17', '2021-06-07 12:31:17'),
(35858, 1006, 28358, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following reply from MHTContractrequest mhtcontractrequest@molinahealthcare.com:  Sub: Attn: Contracting Team - CBUC/GWMC - Molina   \"Good Afternoon Mr. Adil Abbas  I am doing fine, how do are you doing?  I did research for Coastal Bend Urgent Care and it does not show up in our system.  I tried both the Tax id and Group NPI. Please complete this contract request form and return along with a current W-9 to fax number: 877-900-5655 Attn: Contracting Team or email form to: mhtcontractrequest@molinahealthcare.com  Please let me know if you need further information or assistances.  Thank you  David Balli Representative Provider Service  II Molina Healthcare of Texas, Inc. 4316 South McColl Road Edinburg, TX  78539 I Phone: (956) 532-5211 Righ tfax: (877) 900-8454 Email: david.balli@molinahealthcare.com\"  The form was filled out and sent to mhtcontractrequest@molinahealthcare.com, form is attached in the main group task for reference. ', NULL, NULL, '2021-06-25 12:43:03', '2021-06-25 12:43:03'),
(35859, 1006, 28358, NULL, '2021-07-08 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-07-01 15:54:57', '2021-07-01 15:54:57'),
(35860, 1006, 28358, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-08-03 14:06:24', '2021-08-03 14:06:24'),
(35861, 1006, 28358, NULL, '2021-08-10 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-08-03 14:06:24', '2021-08-03 14:06:24'),
(35862, 11056, 28358, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good evening!  Hope all is well. Please provide me with the latest updates of the enrollment status of following providers & practice and the secondary location too. Kindly also update me about the applications and forms submitted to you regarding enrollment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Furthermore,if documents and information is needed please let me know. Please don\'t hesitate to contact me directly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 15:51:20', '2021-08-18 15:51:20'),
(35863, 11056, 28358, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning,  Happy Thursday!!  Hope you are doing well.  Per information on our system, service location  301 S. Hillside Drive is in process  of credentialing.  Service location 504  A  Houston Street, we are missing a contract request form, could you please fill out form and submit back to me at your earliest convenience?  Individual providers are not contracted under Urgent Care Facility.  Molina contracts facility directly.     Hope this information helps.  Thank you        Juliana Mata | Associate Specialist Provider Contracts  Molina Healthcare Of Texas  Molina Healthcare Of Texas, Inc  Juliana.Mata@Molinahealthcare.com  1660 Westridge Circle N.  Irving, TX 75038  \'  (888) 562-5442 ext 200249', NULL, NULL, '2021-08-24 14:05:01', '2021-08-24 14:05:01'),
(35864, 11056, 28358, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope all is well. Here is the filled contract request form for the secondary service location 504-A, Houston Street. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Furthermore, if any additional information is required please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 15:02:39', '2021-09-03 15:02:39'),
(35865, 11056, 28358, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-09-24 11:45:07', '2021-09-24 11:45:07'),
(35866, 11056, 28358, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-06 12:37:53', '2021-10-06 12:37:53'),
(35867, 11056, 28358, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-10-14 15:47:50', '2021-10-14 15:47:50'),
(35868, 11056, 28358, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-10-22 10:21:51', '2021-10-22 10:21:51'),
(35869, 11056, 28358, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-11-09 14:11:42', '2021-11-09 14:11:42'),
(35870, 11056, 28358, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-11-24 12:13:51', '2021-11-24 12:13:51'),
(35871, 11056, 28358, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-06 17:02:02', '2021-12-06 17:02:02'),
(35872, 11056, 28358, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Please see the attachment', NULL, NULL, '2021-12-21 17:39:27', '2021-12-21 17:39:27'),
(35873, 1006, 28359, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35874, 1006, 28359, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Request a copy of the group contract, as Ambetter is already added under it. I Will update the task once received. ', NULL, NULL, '2021-05-05 12:29:08', '2021-05-05 12:29:08'),
(35875, 1006, 28359, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following enrollment query @ AM.Austin@SuperiorHealthPlan.com & SHP.NetworkDevelopment@superiorhealthplan.com:  Sub: Enrollment Query - CBUC/GWMC -  Superior Health/Ambetter  \"Hello,  I wanted to verify if the following group and providers were enrolled with Superior Healthplan & Ambetter under the mentioned addresses:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Katherine Paterson NPI# 1164776548  Provider Name: Mercedita Flynn NPI# 1619166188  Provider Name: Jennifer Tudor NPI# 1720455835  Please get back to me as soon as you\'re able. Thank you. \"', NULL, NULL, '2021-06-09 09:49:06', '2021-06-09 09:49:06'),
(35876, 1006, 28359, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Sent f/u email @ Account Management - Corpus Christi AM.CorpusChristi@superiorhealthplan.com:  Sub: Group Contract Query - CBUC/GWMC - Ambetter  \"Hello,   I hope you\'re doing well, I wanted to verify if the following group was enrolled with Superior & Ambetter and what the effective date was for the group contract. The group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264 TIN# 81-1890349  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-29 16:29:16', '2021-06-29 16:29:16'),
(35877, 1006, 28359, NULL, '2021-08-13 00:00:00.000', 'Approved', 'All providers added in the given location under group address. ', NULL, NULL, '2021-08-06 12:56:38', '2021-08-06 12:56:38'),
(35878, 1006, 28360, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35879, 3040, 28360, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: trpndataentry@trpnppo.com, providerrelations@trpnppo.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || TRPN ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers TRPN for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:43:54', '2021-06-07 12:43:54'),
(35880, 1006, 28360, NULL, '2021-07-02 00:00:00.000', 'In Process', 'Sent f/u email @ trpndataentry@trpnppo.com & TRPN Provider Relations providerrelations@trpnppo.com:  Sub: Enrollment Status/Request - CBUC/GWMC - TRPN  \"Hello, I hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled.   The information is as follows: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-25 09:23:05', '2021-06-25 09:23:05'),
(35881, 11056, 28360, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email sent to : trpndataentry@trpnppo.com  Sub : Enrollment Requisition Query - Coastal Bend Urgent Care & George West Medical Clinic - TRPN  Greetings,  Hope you\'re doing well, we wanted to verify if the following group and providers were enrolled with TRPN or not? If so, what is required to get them enrolled. The information is as follows:  Practices: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Providers: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Kindly get back to me as soon as possible.  Thank you!', NULL, NULL, '2021-07-06 16:50:10', '2021-07-06 16:50:10'),
(35882, 1006, 28360, NULL, '2021-08-17 00:00:00.000', 'In Process', 'As per my discussion with TRPN we need to send a provider update form to them, requested a copy, and sent it to trpndataentry@trpnppo.com:  Sub: Provider Update Form - CBUC/GWMC - TRPN  \"Hello,   Please find the attached provider update forms for our providers. Please let me know if anything else is required to continue.   Thank you!\"  Attached for reference in provider tasks. ', NULL, NULL, '2021-08-10 12:43:04', '2021-08-10 12:43:04'),
(35883, 11056, 28360, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	trpndataentry@trpnppo.com  Sub : Enrollment Status Updates - CBUC/GWMC - TRPN  Good morning!  Hope all is well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you need any documents or information regarding this feel free to contact me.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 14:08:11', '2021-08-18 14:08:11'),
(35884, 11056, 28360, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to :  trpndataentry@trpnppo.com, providerrelations@trpnppo.com   & AVasquez@trpnppo.com  Sub : Provider Update Form - CBUC/GWMC - TRPN   Good afternoon!  Hope this email finds you well. Please inform me with the latest updates regarding enrollment status of the following providers under the practice in TRPN. Please also inform me about the provider\'s update forms.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Monica Gonzalez Provider NPI# 1871132811  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Flynn, Mercedita N Provider NPI# : 1619166188  If you have any questions or queries or need any information or documents feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 13:32:30', '2021-08-24 13:32:30'),
(35885, 11056, 28360, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Approval Email received from : trpndataentry@trpnppo.com  Sub : RE: Enrollment Status Updates - CBUC/GWMC - TRPN  Hi,     This request is completed,     Provider Mercedita Flynn is Active, effective date 01/01/2017,  Provider Katherine Paterson is Active, effective date 01/01/2017,  Provider Monica Gonzalez is Active, effective date 01/01/2021.    Providers approved now group is in processing', NULL, NULL, '2021-09-03 14:46:35', '2021-09-03 14:46:35'),
(35886, 11056, 28360, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email sent to : 	efry@trpnppo.com  Sub : Group Enrollment Verification - CBUC / GWMC - TRPN  Hope this email finds you well. Please provide me with the welcome or approval letter and effective date for the facility mentioned below with TRPN under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-24 11:12:05', '2021-09-24 11:12:05'),
(35887, 11056, 28360, NULL, '2021-10-01 00:00:00.000', 'Approved', 'Email received from : providerrelations@trpnppo.com  Sub : RE: Group Enrollment Verification - CBUC / GWMC - TRPN  Good morning Ahmed,  Effective date for below group is 01/01/2017, also, please see attached for your review.  Thank you,  Brixcia Castillo Provider Relations Department 6970 O’Bannon Drive  Las Vegas, Nevada 89117 Phone: (866) 393-0966 Fax: (619) 600-4818 providerrelations@trpnppo.com www.trpnppo.com', NULL, NULL, '2021-09-24 13:39:50', '2021-09-24 13:39:50'),
(35888, 1006, 28361, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35889, 3040, 28361, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: dhpcontracting@dchstx.org  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned providers in Driscoll  for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you    ', NULL, NULL, '2021-06-07 10:37:52', '2021-06-07 10:37:52'),
(35890, 1006, 28361, NULL, '2021-07-02 00:00:00.000', 'In Process', 'We received the following email from dhpcontracting@dchstx.org:  Sub: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  \"Good afternoon,  Please complete the attached documents for each provider and email them to dhpcontracting@dchstx.org.  We will also need a current PAA or Collaborative agreement for each of the mid-level practitioners.  Thank you Karla Claunch\"  Requested Ryan to send us copies of the PAA/Collaborative agreement to avoid any delays.   \"Hello Ryan,  We need updated copies of the following documents for the mentioned providers: Mercedita Flynn An updated copy of AANP CertificationFrank Dehnisch An updated copy of Malpractice Also, we would like copies of current PAA or Collaborative agreements for all the mid-level providers, please send these over as soon as you\'re able to. Thank you!\"', NULL, NULL, '2021-06-25 13:48:32', '2021-06-25 13:48:32'),
(35891, 1006, 28361, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Still waiting on Ryan to send us PAA/Collab agreement for all providers to proceed with this request, sent another reminder via hangouts/google chat:  \"Hello Ryan,  I just wanted to ask if it would be possible for you to get us the following information: We need updated copies of the following documents for the mentioned providers:  Mercedita Flynn An updated copy of AANP Certification Frank Dehnisch An updated copy of Malpractice  Also, we would like copies of current PAA or Collaborative agreements for all the mid-level providers, please send these over as soon as you\'re able to.  Thank you!  Also, if you could send us the update CLIA of both CBUC & GWMC\"', NULL, NULL, '2021-07-14 16:27:18', '2021-07-14 16:27:18'),
(35892, 11056, 28361, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Still waiting for the  Updated MALPRACTICE : Frank Dehnisch  Updated  AANP Certification : Mercedita Flynn  by Ryan.', NULL, NULL, '2021-08-18 15:03:34', '2021-08-18 15:03:34'),
(35893, 11056, 28361, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Still waiting for the  Updated MALPRACTICE : Frank Dehnisch  Updated  AANP Certification : Mercedita Flynn  by Ryan.', NULL, NULL, '2021-08-24 17:09:12', '2021-08-24 17:09:12'),
(35894, 11056, 28361, NULL, '2021-09-24 00:00:00.000', 'In Process', 'Good evening Karla!  Hope this email finds you well. Here are the forms with attached documents in the Pdf too with W9s, which you requested for in the previous email for enrollment process. Please find the attachments.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Primary Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# 1164776548  Provider Name: Flynn, Mercedita  Provider NPI# 1619166188  Provider Name: Gonzalez, Monica Provider NPI# 1427509264  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, '2021-09-17 12:16:29', '2021-09-17 12:16:29'),
(35895, 11056, 28361, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  Thank you for these requests but, the disclosure statements were not attached for Monica Gonzalez NP and Katherine Paterson NP.  Please email these directly to me when completed.  They are all now in the credentialing process.  Please allow 60-90 days to complete.  Once complete, you will receive a welcome letter with their effective date.  Thank you  Karla Claunch   ', NULL, NULL, '2021-09-28 16:58:13', '2021-09-28 16:58:13'),
(35896, 11056, 28361, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  My apologies,  I am just noticing that this practice is currently not participating with us.  All providers requested are mid-level who will need a supervising physician.  The physician will also need to be a Driscoll Health Plan participating physician.  If their supervising physician is not already credentialed with us, we will also need to credential them.  We will also need the current PAA or Collaborative agreement between the NP’s and supervising physician.  They should have one on file within the practice.  We are withdrawing these providers  due to not currently having a supervising physician on file for this practice.  We can re-activate them once the remaining, required information is received and they have an established, participating, supervising physician.  We look forward to working with you and eager to hear from you again soon.  Please let me know if you need any further assistance.  Karla Claunch  ', NULL, NULL, '2021-10-06 16:30:56', '2021-10-06 16:30:56'),
(35897, 11056, 28361, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : Karla.Claunch@dchstx.org  Sub : Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Hey Karla!  Hope you had a great weekend. You don\'t need to apologise. We do have a supervising physician for this practice and want to let him participate with Driscoll Health Plan. Please suggest to me the procedure to credential the supervising physician as soon as possible.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a wonderful day!', NULL, NULL, '2021-10-14 15:44:26', '2021-10-14 15:44:26'),
(35898, 11056, 28361, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon,  I wish the weekend was much longer but, here we are.  We will need the same documents for the supervising physician and he must carry them on his license.  Please send a Request for Contact as well as the DHP addendum and disclosure as below.', NULL, NULL, '2021-10-22 08:49:23', '2021-10-22 08:49:23'),
(35899, 11056, 28361, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Sub : Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Please find the attached forms for the Supervising physician enrollment with Driscoll. Please accept my apology for the delay. If any corrections are required please let me know.  Supervising Physician Details: Name : Frank Dehnisch NPi # : 1952376345 CAQH I.D # : 10577534  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a blessed day!', NULL, NULL, '2021-11-09 14:33:20', '2021-11-09 14:33:20'),
(35900, 11056, 28361, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch   Provided them with their requirement.', NULL, NULL, '2021-11-24 10:02:39', '2021-11-24 10:02:39'),
(35901, 11056, 28361, NULL, '2021-12-01 00:00:00.000', 'In Process', '	 Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Hello,  Thank you for this request.  Before I begin, the addendum needs to be completed with all information.  The disclosure is named and signed by Mercedita Flynn so, we will need his own, signed by him please.  This provider will not be processed until this information is received.  Your prompt attention will avoid delays and withdrawal.  I look forward to hearing from you soon.  Thank you  Karla Claunch   Provided them with their requirement.', NULL, NULL, '2021-11-24 10:02:42', '2021-11-24 10:02:42'),
(35902, 11056, 28361, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good morning!  Hope this email finds you well. Here you go. Please find the corrected one in the attachment.  If anything else is needed feel free to reach out to me.  Take Care!  Thank you!', NULL, NULL, '2021-12-06 16:39:51', '2021-12-06 16:39:51'),
(35903, 11056, 28361, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email received from:  Karla.Claunch@dchstx.org  Sub:  Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Good afternoon,  You only sent one disclosure, it was for Mercedita which I already have.   I am needing one for both of these providers please-Monica Gonzalez NP and Katherine Paterson NP  They are now in process.  Please allow 60-90 days to complete the process.  I am looking forward to hearing back from you soon with these disclosures and all of their PAA/Collaborative Agreements  Thank you', NULL, NULL, '2021-12-17 14:47:16', '2021-12-17 14:47:16'),
(35904, 11056, 28361, NULL, '2021-12-29 00:00:00.000', 'In Process', '	 Email sent to: Karla.Claunch@dchstx.org  Sub: Fwd: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope you are having a blessed day. Please find the attached disclosure for Monica Gonzalez and Katherine Paterson. We will provide you with their PAA/Collaborative Agreements near in the future.  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Take Care!  Thank you! Have a wonderful day!', NULL, NULL, '2021-12-22 11:11:09', '2021-12-22 11:11:09'),
(35905, 19067, 28361, NULL, '2022-01-06 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||   Good afternoon!  Hope this email finds you well. Kindly do provide me with the recent accomplishments of the credentialing process of the below-mentioned providers under facility TIN.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location	504A Houston Street, George West, TX 78022-3663 Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   Please get back to me soon with the updates and if credentialing is completed do provide me with effective dates and welcome letters.  Thank you! Have a wonderful weekend!', NULL, NULL, '2021-12-30 11:00:57', '2021-12-30 11:00:57'),
(35906, 19067, 28361, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||  Greetings!  Any updates on the previously mentioned request.  Thanks, Hammad Ahmed.', NULL, NULL, '2022-01-09 22:23:01', '2022-01-09 22:23:01'),
(35907, 19067, 28361, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: Karla.Claunch@dchstx.org  Subject: Re: FW: FW: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Driscoll ||    Good morning,  I sent the welcome packet and contract 12/28/2021 to the credentialing contact email we have on file.  I have attached everything to this email for you.    ', NULL, NULL, '2022-01-10 09:24:39', '2022-01-10 09:24:39'),
(35908, 1019, 28361, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Received the following email from Karla.Claunch@dchstx.org  Good morning,  I sent the welcome packet and contract 12/28/2021 to the credentialing contact email we have on file.  I have attached everything to this email for you.  Effective date: 01/01/2022 Attached is the Welcome Letter', NULL, NULL, '2022-02-02 13:11:14', '2022-02-02 13:11:14'),
(35909, 1006, 28362, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35910, 1006, 28362, NULL, '2021-05-21 00:00:00.000', 'Initiated', 'Submitted enrollment request via Anci-Care\'s website:   \"Apply to ACS Network  Congratulations on taking your first step to becoming a Provider-Partner in the ACS Provider Network. Your account has been established. An email with instructions on how to log in and begin the application process has been sent to your email address. Please use the link provided along with the login (your email address) to begin the application process.  Thank you for your interest in Ancillary Care Services.\"', NULL, NULL, '2021-05-05 13:16:00', '2021-05-05 13:16:00'),
(35911, 1006, 28362, NULL, '2021-06-15 00:00:00.000', 'In Process', 'Sent following enrollment query @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,  We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to. Thank you. \"', NULL, NULL, '2021-06-08 16:15:47', '2021-06-08 16:15:47'),
(35912, 1006, 28362, NULL, '2021-07-02 00:00:00.000', 'In Process', 'The previous email was sent to an incorrect address, sent corrected email @ providerdevelopment@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello,    We submitted an enrollment request last month for our group and wanted to get a status update on it, the group information is as follows:  Group Name: Coastal Bend Urgent Care, LLC NPI# 1427509264TIN# 81-1890349  Primary Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Please get back to me as soon as you\'re able to.  Thank you.\"  ', NULL, NULL, '2021-06-25 17:05:50', '2021-06-25 17:05:50'),
(35913, 1006, 28362, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Received following notification from email:  \"Your message to providerdevelopment@anci-care.com couldn\'t be delivered. The group providerdevelopment only accepts messages from people in its organization or on its allowed senders list, and your email address isn\'t on the list.\"  Sent corrected email @ ACS VIP Providers vipproviders@anci-care.com.', NULL, NULL, '2021-07-14 14:55:53', '2021-07-14 14:55:53'),
(35914, 1006, 28362, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Received the following update from Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hi Brad,  Our Medical Advisory Committee is meeting tomorrow. Please allow 7-10 business days after approvals for me to send you an official letter.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\"', NULL, NULL, '2021-07-16 16:56:12', '2021-07-16 16:56:12'),
(35915, 1006, 28362, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,   I wanted to get an update regarding this request, please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-07-28 12:29:38', '2021-07-28 12:29:38'),
(35916, 1006, 28362, NULL, '2021-08-13 00:00:00.000', 'In Process', 'We received the following update from jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Good Morning,  I show that Coastal Bend Urgent Care, LLC And ACS are currently contracted since 7/20/2017. Records indicate that you are due for credentialing.  Please see the attached Re-credentialing Profile.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com\"  Replied with:  \"Hello Jennifer,  Please find the attached information, do let me know if you need anything else.  Thank you. \"', NULL, NULL, '2021-08-06 15:12:14', '2021-08-06 15:12:14'),
(35917, 1006, 28362, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Sent f/u email @ Jennifer MaligayaACS jmaligaya@anci-care.com:  Sub: Enrollment Query - CBUC/GWMC - Anci-Care  \"Hello Jennifer,  I hope you\'re doing well, I just wanted to check in on the status of enrollment for our group. Can you please get back to me on this?  Thank you.\"', NULL, NULL, '2021-08-16 16:07:41', '2021-08-16 16:07:41'),
(35918, 11056, 28362, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.     Recredentialing is complete just waiting on the approval meeting on 9/16.     No further action is necessary.  Claims are still being processing for this provider.     Jennifer Maligaya is no longer with ACS/HealthSmart.     Please continue to use VIPproviders@anci-care.com for updates.     New provider agreements please email me:  patti.davidson@healthsmart.com     Thank you,     Patti Davidson | Manager, Network Development  HealthSmart | Network Solutions  Office: 972 388 3091 | Fax: 214 574 1121  patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-08-23 17:10:35', '2021-08-23 17:10:35'),
(35919, 11056, 28362, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates,effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-03 14:32:03', '2021-09-03 14:32:03'),
(35920, 11056, 28362, NULL, '2021-09-21 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Good morning!  Hope all is well. Could you please provide me the enrollment updates, effective dates and welcome or approval letter for the following providers and practice soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Provider Name: Monica Gonzalez Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-14 14:30:14', '2021-09-14 14:30:14'),
(35921, 11056, 28362, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Coastal Bend Urgent Care is already contracted with ACS.  Recredentialing is complete just waiting on the approval meeting on 9/16.  No further action is necessary.  Claims are still being processing for this provider.    Thank you, Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-09-27 10:32:40', '2021-09-27 10:32:40'),
(35922, 11056, 28362, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Hi.   The provider below is already contracted.  We are only recredentialing the site.     You will receive the recredentialing approval letter from our credentialing department after 2 weeks.', NULL, NULL, '2021-10-06 14:50:04', '2021-10-06 14:50:04');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(35923, 11056, 28362, NULL, '2021-10-14 00:00:00.000', 'Approved', 'Email received from : Betsy.Eggleston@healthsmart.com & pdavidson@anci-care.com  Sub : Re: Enrollment Query - CBUC/GWMC - Anci-Care  Hi.   Coastal Bend Urgent Care is already contracted with ACS.  Recredentialing is complete.  Both locations are loaded.  This was only a recredentialing provider update.  The facilities can see patients since this was already contracted. No further action is necessary.  Claims are still being processing for this provider.  Your provider agreement effective date is 7/20/2017.  The recredentialing date does not change the provider agreement effective date.   Please see the attachment.', NULL, NULL, '2021-10-07 10:53:33', '2021-10-07 10:53:33'),
(35924, 1006, 28363, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35925, 3040, 28363, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@triwest.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Triwest for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-06-07 13:00:06', '2021-06-07 13:00:06'),
(35926, 11056, 28363, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Email sent to : providerservices@triwest.com  Sub : Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Triwest ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers with Triwest for our group under the below locations.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548    Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# : 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you! Have a blessed day!', NULL, NULL, '2021-06-24 13:14:22', '2021-06-24 13:14:22'),
(35927, 1006, 28363, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Hello,   I hope you\'re doing well, I wanted to get an update regarding the status of enrollment for our group and providers mentioned in the previous email.   Please get back to me as soon as possible.  Thank you.', NULL, NULL, '2021-07-13 17:28:24', '2021-07-13 17:28:24'),
(35928, 1006, 28363, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Spoke with the representative (Margo Rose, O: (916) 389-6334) ​and she said that the request is in-process and we should send an email to credentialing@triwest.com, sent f/u email.', NULL, NULL, '2021-07-26 16:06:27', '2021-07-26 16:06:27'),
(35929, 1006, 28363, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Sent f/u email @ credentialing@triwest.com:  Sub: Enrollment Status - CBUC/GWMC - Triwest  \"Hello,   We\'re still waiting on an update on this request. Please get back to me as soon as you\'re able to.  Thank you. \"', NULL, NULL, '2021-08-03 16:13:28', '2021-08-03 16:13:28'),
(35930, 11056, 28363, NULL, '2021-08-26 00:00:00.000', 'In Process', 'Email sent to : 	credentialing@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I wanted to get an update regarding the status of enrollment for our group and providers mentioned below:  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-18 16:16:27', '2021-08-18 16:16:27'),
(35931, 11056, 28363, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : credentialing@triwest.com, providerservices@triwest.com, jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening!  Hope this email finds you well. I am still waiting to get an update regarding the status of enrollment for our group and providers mentioned below. Please respond to me as soon as possible.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-24 10:41:48', '2021-08-24 10:41:48'),
(35932, 11056, 28363, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : jmonson@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good evening Jess!  Hope this email finds you well. Thank you so much for the prompt response. Please provide me with the welcome or approval letters for the below mentioned providers and practice as soon as possible.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Practice Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider 1: Provider Name : Paterson, Katherine D Provider NPI# : 1164776548   Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# :1619166188  Provider 3:   Provider Name: Gonzalez, Monica Provider NPI# 1871132811  If you need any documents or information regarding this feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-03 14:43:42', '2021-09-03 14:43:42'),
(35933, 11056, 28363, NULL, '2021-10-01 00:00:00.000', 'In Process', 'mail received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-09-24 14:52:17', '2021-09-24 14:52:17'),
(35934, 11056, 28363, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : mlarsen@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential  Good Morning,  The providers : Paterson, Katherine D  and Flynn, Mercedita N have been added for Aperture review as of 9/5/2021.  This credentialing process may take between 30-90 days and once approved you will receive an approval letter with contracted dates. If you have further questions please reach out to the email listed.   providerdataupdate@triwest.com  Thank you for caring for our nation’s veterans.  Michelle Larsen Provider Services mlarsen@Triwest.com 480-481-5549', NULL, NULL, '2021-10-06 12:55:11', '2021-10-06 12:55:11'),
(35935, 11056, 28363, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : providerdataupdate@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest  Good afternoon!  Hope this email finds you well. Please provide me with the latest updates regarding the providers and facility credentialing applications mentioned below under Tax I.D and both locations. And still waiting for the welcome letters for the providers.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324 Secondary Location	504A Houston Street, George West , TX 78022-3663  Provider Name	NPI Katherine Paterson	1164776548 Mercedita Flynn	1619166188 Monica Gonzalez	1871132811   If you have any questions or concerns or require any information or documents please let me know. Eagerly, waiting for the response.  Thank you! Have a great weekend!', NULL, NULL, '2021-10-14 15:55:56', '2021-10-14 15:55:56'),
(35936, 11056, 28363, NULL, '2021-10-29 00:00:00.000', 'In Process', 'Email received from : ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential   Talha,  I removed Michelle from the email as she is no longer in the same department.   We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.  The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548        Cecilia Carroll Direct Contract Manager TriWest Healthcare Alliance  O:  (623) 435-3343 F:  (866) 549-4618 ccarroll@triwest.com www.triwest.com', NULL, NULL, '2021-10-22 12:03:27', '2021-10-22 12:03:27'),
(35937, 11056, 28363, NULL, '2021-11-16 00:00:00.000', 'In Process', 'Email received from: ccarroll@triwest.com  Sub : Enrollment Status Query - CBUC & GWMC - Triwest   TriWest Classification: Confidential     Talha,     Reminder, Michelle is no longer in this department.      See below status of your urgent care and providers in question.     We have both urgent cares loaded at the facility level as of 6/1/20 for CCN.     The providers below have credentialed but are in the process of being loaded.  You will receive the credentialing letter once completed.  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Provider is still in the cred process, pending with Aperture as of 9/5/21.  The credentialing process takes 30-90 days to complete.  Katherine Paterson  1164776548              Cecilia Carroll  Direct Contract Manager  TriWest Healthcare Alliance  O:  (623) 435-3343  F:  (866) 549-4618  ccarroll@triwest.com  www.triwest.com', NULL, NULL, '2021-11-09 11:14:07', '2021-11-09 11:14:07'),
(35938, 11056, 28363, NULL, '2021-12-01 00:00:00.000', 'In Process', 'Email received from:  sbachman@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  TriWest Classification: Confidential     Julie,  Please process the provider in Pending status and provider the effective dates for all three providers.     Group Name  Coastal Bend Urgent Care, LLC  Tax ID  81-1890349  Group NPI  1427509264  Primary Location  301 S HILLSIDE DR STE 4, BEEVILLE , TX 78102-5324  Secondary Location  504A Houston Street, George West , TX 78022-3663  Provider Name  NPI  Katherine Paterson  1164776548  Mercedita Flynn  1619166188  Monica Gonzalez  1871132811     Sincerely,  Sandra Bachman  Team Lead, Provider Data Ops / TriWest Healthcare Alliance  P: 1 (855) 722-2838  F: (866) 589-7693  www.triwest.com', NULL, NULL, '2021-11-24 13:02:41', '2021-11-24 13:02:41'),
(35939, 11056, 28363, NULL, '2021-12-13 00:00:00.000', 'In Process', 'Email sent to:  	jmiller@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest   Good morning Julie!  Hope this email finds you well. Please respond to this query at your earliest convenience. Provide us with the effective dates and welcome letters for all three providers soon.  Eagerly, waiting for your reply.  Thank you! Have a great day!', NULL, NULL, '2021-12-06 18:03:09', '2021-12-06 18:03:09'),
(35940, 11056, 28363, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Email received from: jmonson@triwest.com & Credentialing@triwest.com & sdevi@triwest.com  Sub: Enrollment Status Query - CBUC & GWMC - Triwest  Talha,  Coastal Bend Urgent Care LLC, 301 S Hillside Dr, Ste 4 Beeville TX – 78102 and NPI: 1427509264 credentialed as of date 09/27/2019.  The location has been added. Effective 7/26/2021.  Here is the provider information that you have requested  Providers - Effective dates   Patterson – 10.15.21  Flynn – 9.29.21  Gonzalez – 10.5.21  Thank you.  Sailaja Devi Provider Credentialing Specialist TriWest Healthcare Alliance  Ph: (480) 530 4403 Fax: (866) 549-4610 Sdevi@triwest.com www.triwest.com', NULL, NULL, '2021-12-14 15:41:24', '2021-12-14 15:41:24'),
(35941, 1006, 28364, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35942, 1005, 28364, NULL, '2021-06-09 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, '2021-06-01 14:20:43', '2021-06-01 14:20:43'),
(35943, 1006, 28371, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35944, 3040, 28371, NULL, '2021-06-14 00:00:00.000', 'In Process', 'Email sent to: providerservices@renaissancefamily.com   Subject:Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Renaissance Physicians ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Renaissance Physicians for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you  ', NULL, NULL, '2021-06-07 12:35:13', '2021-06-07 12:35:13'),
(35945, 1006, 28371, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email to correct email address @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,  I hope you\'re doing well, we want to enroll the following group and providers with Renaissance Physicians, please let me know what is required to complete this request, the information is as follows:  Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, Beeville, TX 78102-5324 Secondary Practice Address: 504A Houston Street, George West, TX 78022-3663  Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson  Provider NPI# 1164776548  Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 16:55:38', '2021-06-24 16:55:38'),
(35946, 1006, 28371, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Sent f/u email @ txgqproviderrelations@healthspring.com:  Sub: Enrollment Request - CBUC/GWMC - Renaissance Physician  \"Hello,   I wanted to get an update regarding the status of our request, please get back to me as soon as possible.  Thank you.\"', NULL, NULL, '2021-07-13 17:24:46', '2021-07-13 17:24:46'),
(35947, 11056, 28371, NULL, '2021-08-25 00:00:00.000', 'In Process', '	 Email sent to : 	txgqproviderrelations@healthspring.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  Good afternoon!  Hope you are doing well. I want to inquire about the enrollment status of the below mentioned practice and providers. Please respond to me soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-18 13:01:16', '2021-08-18 13:01:16'),
(35948, 11056, 28371, NULL, '2021-09-01 00:00:00.000', 'In Process', 'email sent to :  txgqproviderrelations@healthspring.com, joann.alanis@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  Good afternoon!  Hope you are doing well. I am still waiting to get an update regarding the enrollment status of the below mentioned practice and providers since july.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  If you have any questions or concerns or need documents please let me know.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-24 14:44:13', '2021-08-24 14:44:13'),
(35949, 11056, 28371, NULL, '2021-09-02 00:00:00.000', 'Not Eligible', 'Email received from : cresta.smith@careallies.com  Sub : Enrollment Status Query - Renaissance Physicians - CBUC/GWMC  These providers are not in the renaissance service area. We are only in the greater Houston area.     Thanks  Cresta', NULL, NULL, '2021-08-25 14:23:30', '2021-08-25 14:23:30'),
(35950, 1006, 28372, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 09:34:32', '2021-05-05 09:34:32'),
(35951, 1005, 28372, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Awaiting Molina\'s enrollment.', NULL, NULL, '2021-06-07 10:16:17', '2021-06-07 10:16:17'),
(35952, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'Initiated', 'Email sent to: david.balli@molinahealthcare.com  Subject: Enroll Group & Providers || Coastal Bend Urgent Care & George West Medical Clinic || Group & Providers || Molina Health||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers Molina Health for our group under the below locations.   Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324  Practice Name: George West Medical Clinic Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 504A Houston Street George West , TX 78022-3663  Provider 1: Provider Name: Rabagos, Katherine Provider NPI# 1134415631  Provider 2:   Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider 3:   Provider Name: Tudor, Jennifer M Provider NPI# 1720455835  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-12-21 17:43:05', '2021-12-21 17:43:05'),
(35953, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'We received the following update from MHTContractrequest MHTContractrequest@molinahealthcare.com:  Sub: Molina Provider Contract - Coastal Bend Urgent Care, LLC  \"Good Afternoon,  Happy Wednesday! Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for (Coastal Bend Urgent Care, LLC ) to contract under TAX ID number (81-1890349).  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below: EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com 888-562-5442 x200249   Have a wonderful day! Thank you, Tyhesha Price MHT| Provider Contracts Molina Healthcare of Texas, Inc. 1660 Westridge Circle N Irving, TX 75038 Mhtcontractrequest@Molinahealthcare.com\"', NULL, NULL, '2021-12-21 17:43:39', '2021-12-21 17:43:39'),
(35954, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'We received the following update from Juliana.Mata@molinahealthcare.com:  Sub: Molina Contract Packet - Coastal Bend Urgent Care LLC DBA Beeville Medical Clinic  \"Good afternoon,  Happy Monday!!  Hope you are doing well.  I am following up to my previous email. Please be advised unless all forms are returned, we will not be able to continue contracting process.  any assistance will be greatly appreciated.  Thank you in advance  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249\"  Replied with the requested information:  \"Hello Juliana,   I apologize for the delay, here\'s the requested information hopefully it suffices. We also have a secondary location and the address is as follows: 504A Houston Street, George West, TX 78022-3663  Do let me know if anything else is required to proceed.\"', NULL, NULL, '2021-12-21 17:44:13', '2021-12-21 17:44:13'),
(35955, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good evening!  Hope all is well. Please provide me with the latest updates of the enrollment status of following providers & practice and the secondary location too. Kindly also update me about the applications and forms submitted to you regarding enrollment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Provider Details: Provider Name: Flynn, Mercedita N Provider NPI# 1619166188  Provider Name: Katherine Paterson Provider NPI# 1164776548  Furthermore,if documents and information is needed please let me know. Please don\'t hesitate to contact me directly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-12-21 17:44:39', '2021-12-21 17:44:39'),
(35956, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope all is well. Here is the filled contract request form for the secondary service location 504-A, Houston Street. Please see the attachment.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# : 81-1890349 Practice NPI# : 1427509264 Practice Address: 301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Address: 504A Houston Street, George West, TX 78022-3663  Furthermore, if any additional information is required please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 17:45:14', '2021-12-21 17:45:14'),
(35957, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Thank you again for your patience. Thank you for taking the first step to becoming a part of the Molina Healthcare Family. I have received your application for Coastal Bend Urgent Care LLC to contract under TAX ID number 81-1890349.  I am pleased to inform you that I have verified and placed your application in process and it is now with your designated coordinator.  Your designated coordinator will be your source of information for any questions you may have or for status checks. Every Coordinator services certain areas, based on the address information provided on the application; I have provided your Coordinators information.  Also, for an alternative route of provider/facility information, email TexasExpansionContracting@MolinaHealthcare.com  Please see your designated Coordinators information below:  EL PASO, NUECES & TRAVIS Juliana Mata Juliana.Mata@molinahealthcare.com   888-562-5442 x200249', NULL, NULL, '2021-12-21 17:45:36', '2021-12-21 17:45:36'),
(35958, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well. Please provide me with the updates on the credentialing of  the facility mentioned below with Molina Health under the Tax ID with both locations listed below.  Group Name	Coastal Bend Urgent Care, LLC Tax ID	81-1890349 Group NPI	1427509264 Primary Location	301 S HILLSIDE DR STE 4, BEEVILLE, TX 78102-5324 Secondary Location 504A Houston Street, George West, TX 78022-3663  If you need any information or documents related to this please let me know. Waiting for your reply.  Thank you! Have a great weekend!', NULL, NULL, '2021-12-21 17:46:02', '2021-12-21 17:46:02'),
(35959, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub  : Enrollment Status Query - CBUC/GWMC - Molina Health  Good  afternoon,  Happy Wednesday!!  Hope you are doing well.  per information on   our system,  both facilities are in process for credentialing.  Once credentialing process is complete, we will go ahead and forward contract to be loaded  into network billing system.  thank you  for your patience', NULL, NULL, '2021-12-21 17:46:34', '2021-12-21 17:46:34'),
(35960, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from : Juliana.Mata@molinahealthcare.com  Sub : Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Tuesday!!  Hope you are doing well.  Per information on our system, both facilities are credential complete, we are waiting on execution from plan\'s president.  Once PSA is executed,  we will go ahead and forward contract to be loaded into network billing system,  this process might take 30-45 days.', NULL, NULL, '2021-12-21 17:50:08', '2021-12-21 17:50:08'),
(35961, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning Juliana!  Hope you had a great week yet. Please let us know about the execution of the Plan\'s President. Has the PSA been executed yet or not? Is that loaded into your billing system?  Eagerly, waiting to hear back from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-21 17:50:37', '2021-12-21 17:50:37'),
(35962, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good afternoon,  Happy Friday!!  Hope you are doing well.  Per information on our system, both locations are in process of being loaded into the network billing system, this process might take 30-45 days.  Thank you for your patience', NULL, NULL, '2021-12-21 17:51:02', '2021-12-21 17:51:02'),
(35963, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'In Process', 'Email sent to:  Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health  Good morning!  Hope this email finds you well.  Thank you for the update and prompt response. Try to escalate the loading process and let it be completed before the time period.  Have a wonderful day!', NULL, NULL, '2021-12-21 17:51:23', '2021-12-21 17:51:23'),
(35964, 11056, 28372, NULL, '2021-12-28 00:00:00.000', 'Approved', 'Email received from: Juliana.Mata@molinahealthcare.com  Sub: Enrollment Status Query - CBUC/GWMC - Molina Health   Good morning,  Happy Friday!!  Hope you are doing well.  per information on our system, service location 301 S. Hillside Drive is loaded into network billing system with effective date 12/15/2021.  Please see attached for welcome letter.  2nd service location is in process of being loaded into network billing system.  thank you for your patience.     Thank you     Juliana Mata | Associate Specialist Provider Contracts  Please see the attachment', NULL, NULL, '2021-12-21 17:51:53', '2021-12-21 17:51:53'),
(35965, 3040, 28373, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 14:36:45', '2021-05-05 14:36:45'),
(35966, 3040, 28373, NULL, '2021-05-13 00:00:00.000', 'On Hold', 'Waiting for Medicaid enrollment. ', NULL, NULL, '2021-05-06 15:45:32', '2021-05-06 15:45:32'),
(35967, 1006, 28373, NULL, '2021-06-21 00:00:00.000', 'Initiated', 'Submitted enrollment request @ jointchp@texaschildrens.org:  Sub: Enrollment Request - LHC - TCHP  \"Hello,   Please find the attached LOI Questionnaire with the W9, do let me know if anything else  is needed to proceed with the request for enrollment.   Thank you. \"  The enrollment request form is attached for reference in main group task. ', NULL, NULL, '2021-06-14 17:01:58', '2021-06-14 17:01:58'),
(35968, 1006, 28373, NULL, '2021-06-30 00:00:00.000', 'In Process', 'We received the following reply from TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request - LHC - TCHP  \"Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.\"', NULL, NULL, '2021-06-23 17:15:54', '2021-06-23 17:15:54'),
(35969, 1006, 28373, NULL, '2021-07-15 00:00:00.000', 'In Process', 'Sent f/u email @ TCHP CA Contract Admin tchpnetworkmanagement@texaschildrens.org:  Sub: Enrollment Request - LHC - TCHP  \"Hello,   I appreciate the update, could you please verify if the request is still under review and what the expected time-frame is for completion?  Thank you.\"', NULL, NULL, '2021-07-08 16:55:10', '2021-07-08 16:55:10'),
(35970, 11056, 28373, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub :  Enrollment Request - LHC - TCHP  Hello,  Sure, what is the name on the Letter of interest submitted?  -Contracting    Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub :  Enrollment Request - LHC - TCHP  Hello,  Sure thing, the provider name is Oladipo Dada & the group is Ladot Healthcare LLC.   Thank you.', NULL, NULL, '2021-07-16 08:51:20', '2021-07-16 08:51:20'),
(35971, 11056, 28373, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : chpnetworkmanagement@texaschildrens.org  Sub : Enrollment Request - LHC - TCHP  Hello,  The LOI has been received and in process, unable to provide a timeframe at this time.  Thank you for your patience.  -Contracting', NULL, NULL, '2021-07-20 07:12:01', '2021-07-20 07:12:01'),
(35972, 11056, 28373, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to :  tchpnetworkmanagement@texaschildrens.org, jointchp@texaschildrens.org  Sub : Enrollment Request - LHC - TCHP  Good morning!  Hope you are doing well. This is just a follow-up email about the enrollment process of the following providers under the below mentioned practice. Kindly keep me updated with the request . And if you need any information or documents please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Eagerly waiting to hear from you soon. Feel free to reach out to me for any queries.  Thank you! Have a great day!', NULL, NULL, '2021-07-23 10:07:44', '2021-07-23 10:07:44'),
(35973, 11056, 28373, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : FW: Enrollment Request - LHC - TCHP  Please see attached denial letter  Self Note  20210707036801885  OLADIPO A DADA', NULL, NULL, '2021-07-29 10:53:37', '2021-07-29 10:53:37'),
(35974, 11056, 28373, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : FW: Enrollment Request - LHC - TCHP  Good morning!  Hope you are doing well. Please accept my apology. Here is the corrected LOI for the providers and practice mentioned below :  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Eagerly waiting to hear from you soon. Feel free to reach out to me for any queries.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 10:58:42', '2021-08-03 10:58:42'),
(35975, 11056, 28373, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.', NULL, NULL, '2021-08-09 16:09:17', '2021-08-09 16:09:17'),
(35976, 11056, 28373, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Great, thank you so much! Please keep me updated with the progress.  Have a great day!', NULL, NULL, '2021-08-16 10:44:53', '2021-08-16 10:44:53'),
(35977, 11056, 28373, NULL, '2021-09-01 00:00:00.000', 'In Process', 'Email received from : ljramir1@texaschildrens.org & adscott1@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP Subject: Oladipo Dada, MD  Greetings:     Please see the attached for important information regarding your recent application.     Thank you,', NULL, NULL, '2021-08-25 11:00:18', '2021-08-25 11:00:18'),
(35978, 11056, 28373, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : jointchp@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Good morning,  Hope you are doing well. This is just a follow-up email about the enrollment process of the following providers under the below mentioned practice. Kindly keep me updated with the request . And if you need any information or documents please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Eagerly waiting to hear from you soon. Feel free to reach out to me for any queries.  Thank you! Have a great day!', NULL, NULL, '2021-09-01 10:58:56', '2021-09-01 10:58:56'),
(35979, 11056, 28373, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Hello,  We received your  application for Oladipo Dada on 8/26 and it’s currently being processed. Did not receive anything on Atinuke Dada.  Thank you,  Deb', NULL, NULL, '2021-09-13 14:10:25', '2021-09-13 14:10:25'),
(35980, 11056, 28373, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Cristina Izaguirre cxizagui@texaschildrens.org Olaipo Dada,  Please DocuSign LADOT HEALTHCARE LLC..pdf  Thank You, Cristina Izaguirre   Agreement has been signed.  Please see the attachment.', NULL, NULL, '2021-09-23 15:05:33', '2021-09-23 15:05:33'),
(35981, 11056, 28373, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Hello,  Are you asking to be in our network? For a new contract that would require a letter of interest questionnaire (attached) and a w9.  If you are asking to be added to a group that is already in contract, that would require a provider information form (attached) and W9.  Please submit the form that applies to your need.  Thank you', NULL, NULL, '2021-10-06 10:04:20', '2021-10-06 10:04:20'),
(35982, 11056, 28373, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email sent to : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Good morning!  Hope you are doing well. Please find the attached LOI with W-9 for the provider, Atinuke Dada, for a new contract with TCHP. If there are any corrections required please let me know.  Thank you! Take Care!', NULL, NULL, '2021-10-14 14:35:02', '2021-10-14 14:35:02'),
(35983, 11056, 28373, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : tchpnetworkmanagement@texaschildrens.org  Sub : Fwd: FW: Enrollment Request - LHC - TCHP  Hello,     Thank you for your interest in our health plan’s network. Your LOI has been received and communication will be sent out to you once the review has been completed.     Thank you     Liz Ramirez  Contract Specialist  Texas Children’s Health Plan', NULL, NULL, '2021-10-21 15:45:17', '2021-10-21 15:45:17'),
(35984, 11056, 28373, NULL, '2021-11-11 00:00:00.000', 'Approved', 'Approval Email received from: MAMiller@texaschildrens.org  Sub : !secure! Welcome Packet  Hello,   Attached is the Welcome Letter for the provider. If you have any questions please reach out to you Provider Relation Liaison.      Marsha (Ann) Miller Contract Specialist, Contracting 6330 West Loop South Bellaire, Texas 77401 mamiller@texaschildrens.org   Connect With Texas Children’s Health Plan: Website | Flickr | YouTube | The Center for Children and Women  Please see the attachment.', NULL, NULL, '2021-11-04 10:52:55', '2021-11-04 10:52:55'),
(35985, 3040, 28374, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 14:36:45', '2021-05-05 14:36:45'),
(35986, 3040, 28374, NULL, '2021-05-14 00:00:00.000', 'In Process', '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.', NULL, NULL, '2021-05-07 07:38:13', '2021-05-07 07:38:13'),
(35987, 3040, 28374, NULL, '2021-06-02 00:00:00.000', 'In Process', 'I had a word with (Ann T) with Wellcare representative and she send the request to provider rep. to contact regarding the contracting and provider rep. will contact with 07-14 business days.   Ref: 504096521', NULL, NULL, '2021-05-26 12:49:25', '2021-05-26 12:49:25'),
(35988, 1006, 28374, NULL, '2021-06-22 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - LHC - Wellcare  \"Hello,  I want to get an update regarding the enrollment status for the following group and providers, their information is as follows: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Oladipo  Dada Provider NPI# 1760700223  Please get back to me as soon as you\'re able to.   Thank you!\"', NULL, NULL, '2021-06-15 15:40:36', '2021-06-15 15:40:36'),
(35989, 1006, 28374, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Sent f/u email @ \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com:  Sub: Enrollment Status - LHC - Wellcare  \"Hello,   I hope you\'re doing well, I wanted to get an update regarding the enrollment status for our group and providers.   Thank you. \"', NULL, NULL, '2021-07-05 10:05:03', '2021-07-05 10:05:03'),
(35990, 11056, 28374, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status - LHC - Wellcare  Good Afternoon,  The providers are being loaded eff 6.01.2021, We will let you know as soon as they become par.  Thanks Network Development', NULL, NULL, '2021-07-13 13:25:44', '2021-07-13 13:25:44'),
(35991, 11056, 28374, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Status - LHC - Wellcare  Good morning!  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it . Have the providers been loaded  with eff 6.01.2021 ?  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me. Eagerly, waiting to hear from you soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-07-20 07:43:00', '2021-07-20 07:43:00'),
(35992, 11056, 28374, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Good Morning,  Yes, both providers are PAR and effective 6.01.2021 for WellCare HMO and PPO.  Thanks', NULL, NULL, '2021-07-28 16:23:41', '2021-07-28 16:23:41'),
(35993, 11056, 28374, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Good Morning,  The provider is still in process. We will send Welcome Letter once complete. We have requested effective date of 6.01.2021.  Thank You', NULL, NULL, '2021-08-03 11:04:40', '2021-08-03 11:04:40'),
(35994, 11056, 28374, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Good morning!  Hope all is well. Great! We really appreciate your efforts and coordination with us. Please provide us with a welcome letter soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-08-09 16:55:49', '2021-08-09 16:55:49'),
(35995, 11056, 28374, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Good Afternoon,  I am working to locate the other. I will get it to you asap.  Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com', NULL, NULL, '2021-08-16 10:30:36', '2021-08-16 10:30:36'),
(35996, 11056, 28374, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Great! Thank you so much. I\'ll be waiting for it, please send it to us soon when you locate it. Your efforts are highly appreciated.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 12:11:12', '2021-08-23 12:11:12'),
(35997, 11056, 28374, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  Good Morning,   The provider is still in process. We will send Welcome Letter once complete. We have requested effective date of 6.01.2021.   Thank You', NULL, NULL, '2021-09-01 10:23:20', '2021-09-01 10:23:20'),
(35998, 11056, 28374, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Enrollment Status - LHC - Wellcare  &   RE: Dr. Dada Atinuke / CSQ :Case # 00835322  Greetings!  Hope all is well. Please provide the welcome letter soon, whenever the process is completed. Kindly respond to me soon.  Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-13 15:07:20', '2021-09-13 15:07:20'),
(35999, 11056, 28374, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Contacting Rep. application has been submitted for the wellcare welcome letter.  Please see the attachment.', NULL, NULL, '2021-09-23 16:28:36', '2021-09-23 16:28:36'),
(36000, 11056, 28374, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email sent to : Cynthia.Barnett@wellcare.com  Sub : RE: Dr. Dada Atinuke / CSQ :Case # 00835322   Hey Cynthia!  Hope you are doing well. I have again submitted the online application for the provider Dr. Oladipo Dada. Please see the attachment. Please let this one not take too long for the enrollment process because already this provider application was submitted to you before.  Thank you! Have a great day!', NULL, NULL, '2021-09-30 16:46:58', '2021-09-30 16:46:58'),
(36001, 11056, 28374, NULL, '2021-10-13 00:00:00.000', 'Approved', 'Rep : Ana T  Status : Enrolled & in network with Wellcare  Plans : WellCare HMO and PPO  Practice EFF DATE : 06/01/2021    Provider eff date  :07/14/2021 Provider ID 2621797  Wellcare  Line of business : UXR CLR CXL CMD  Ref code : 1576199796  Please see the attachment', NULL, NULL, '2021-10-06 10:36:00', '2021-10-06 10:36:00'),
(36002, 3040, 28375, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 14:36:45', '2021-05-05 14:36:45'),
(36003, 3040, 28375, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || 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 Ladot Healthcare LLC.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-05-05 14:59:33', '2021-05-05 14:59:33'),
(36004, 3040, 28375, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: CSHNproviderrelations@christushealth.org  Subject:  Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || Christus Spohn ||  Greetings,   Can you please advise the process for contracting.   Thanks ', NULL, NULL, '2021-05-25 13:58:26', '2021-05-25 13:58:26'),
(36005, 1006, 28375, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent VM @ 800-419-3461 to Vicki, since emails are not being responded to in a timely manner. ', NULL, NULL, '2021-06-11 13:21:30', '2021-06-11 13:21:30'),
(36006, 3040, 28375, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email sent to: vicki.guerra@christushealth.org   Subject: Enroll Group & Providers || Ladot Healthcare LLC || 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 Ladot Healthcare LLC.  Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.  Thank you', NULL, NULL, '2021-06-30 16:18:37', '2021-06-30 16:18:37'),
(36007, 1006, 28375, NULL, '2021-07-08 00:00:00.000', 'Not Eligible', 'Received the following response from Guerra, Vicki A. vicki.guerra@christushealth.org:  Sub: Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || Christus Spohn ||  \"Hi Adil,  Thanks for your interest in the Spohn Health Network.  We are a narrow network and service areas in the surrounding Coastal Bend. Please see the below service areas with counties we do service. Ladot Healthcare LLC is out of the CSHN service area and we will not be able to extend a contract. I really appreciate your interest in the Spohn Health Network.  Please click on the website below for CSHN. It will give you the map of our services areas based on county.  https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area\"', NULL, NULL, '2021-07-01 10:55:19', '2021-07-01 10:55:19');



INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(36270, 11056, 28412, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : 	joann.alanis@careallies.com, txgqproviderrelations@healthspring.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians  Hey  JoAnn!  Hope you are doing well. It is just a follow-up email to inquire about the enrollment status of the following Practice and providers. Please provide me with the updates soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you further need any information or documents or have any queries feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 10:18:04', '2021-08-16 10:18:04'),
(36271, 11056, 28412, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email received from : Tait.Vimont@careallies.com & joann.alanis@careallies.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians  Space has already responded to this inquiry directly.     Tait Vimont  Provider Engagement Senior Analyst  CareAllies  2800 North Loop West Suite 600  Houston, TX 77092   Email:    Tait.Vimont@CareAllies.com  Telephone:  +1 281.387.4697  Fax:                 +1 832.553.3418  ', NULL, NULL, '2021-08-23 09:40:34', '2021-08-23 09:40:34'),
(36272, 11056, 28412, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : Tait.Vimont@careallies.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians  Hey Tait!  Hope this email finds you well. This is to inquire about the Renaissance physicians group and providers enrollment status. And that was for Cigna Healthspring. Are these insurances affiliated with each other?  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you have any questions or concerns, I am happy to help. Please do not hesitate to contact me directly soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-01 10:15:53', '2021-09-01 10:15:53'),
(36273, 11056, 28412, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email received from : Tait.Vimont@careallies.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians   Yes, that is what I was trying to explain when you were sending the request to additional PODs. Your service area is only Space Center. This will be reviewed this week and there should be updates early next. Thanks.', NULL, NULL, '2021-09-13 11:13:47', '2021-09-13 11:13:47'),
(36274, 11056, 28412, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email received from : Tait.Vimont@careallies.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians   Yes, that is what I was trying to explain when you were sending the request to additional PODs. Your service area is only Space Center. This will be reviewed this week and there should be updates early next. Thanks.   Replied with :    Good morning!  Hope this email finds you well. Ok, I got it. Please accept my apology. Please let my applications be reviewed on time. Thank you so much for your assistance.  Have a great week ahead!', NULL, NULL, '2021-09-13 11:15:43', '2021-09-13 11:15:43'),
(36275, 11056, 28412, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email sent to : Tait.Vimont@careallies.com  Sub : Enrollment Status Query - LHC - Renaissance Physicians   Good morning!  Hope this email finds you well. Have my applications been reviewed by your committee? Have they made a decision yet? Please provide me with the latest updates soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers Details: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  If you have any questions or concerns, I am happy to help. Please do not hesitate to contact me directly soon.  Thank you! Have a great weekend!', NULL, NULL, '2021-09-23 15:17:29', '2021-09-23 15:17:29'),
(36276, 11056, 28412, NULL, '2021-10-13 00:00:00.000', 'Not Eligible', 'Email received from : Tait.Vimont@careallies.com  Sub  : Enrollment Status Query - LHC - Cigna Healthspring  The decision is the original email I sent. You may reapply in one year.  Good morning-   Yes our board came to the conclusion that we have no network need at this time for Ladot and the two providers. While telemedicine is a useful tool for our members, we need physicians in an office and fully dedicated to seeing members in person as a rule, opposed to the exception. If the providers ever become full time office PCPs, they may reapply for consideration.  Yes this decision was made by the Renaissance Physician Board of your service location.   Tait Vimont Provider Engagement Senior Analyst CareAllies 2800 North Loop West Suite 600 Houston, TX 77092  Email:    Tait.Vimont@CareAllies.com Telephone:  +1 281.387.4697 Fax:                 +1 832.553.3418  ', NULL, NULL, '2021-10-06 09:11:10', '2021-10-06 09:11:10'),
(36277, 3040, 28413, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 14:36:57', '2021-05-05 14:36:57'),
(36278, 3040, 28413, NULL, '2021-05-13 00:00:00.000', 'On Hold', 'Waiting for Molina Health approval. ', NULL, NULL, '2021-05-06 13:31:42', '2021-05-06 13:31:42'),
(36279, 1006, 28413, NULL, '2021-06-21 00:00:00.000', 'In Process', 'The request is in process in the main Molina task. Need to allow more time.  ', NULL, NULL, '2021-06-14 16:47:07', '2021-06-14 16:47:07'),
(36280, 1006, 28413, NULL, '2021-07-09 00:00:00.000', 'In Process', 'Received the following reply from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Request - LHC - Molina Health  \"Good Morning,  Thank you for reaching out. However, I believe you have reached the MS Health Plan by mistake. Please see below for information for the TX Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com CONTRACTING MHTContracting2@MolinaHealthCare.Com CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email & request @ MHTContractrequest mhtcontractrequest@molinahealthcare.com:  \"Hello,   Please find the attached provider contract request form with the W9 attached, please let me know if anything else is required.   Thank you. \"  Form attached in group task for reference.', NULL, NULL, '2021-07-02 15:49:42', '2021-07-02 15:49:42'),
(36281, 11056, 28413, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : 	TexasExpansionContracting@molinahealthcare.com, Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Health  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:14:43', '2021-07-13 17:14:43'),
(36282, 11056, 28413, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to :  mhtcontractrequest@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Hey Michele,  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 17:21:07', '2021-07-13 17:21:07'),
(36283, 11056, 28413, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email received from : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good Evening –     Happy Tuesday! Hope you are doing well. I apologize for the delay. I am unable to locate any records for the below providers. When did you submit your request. Please complete the attached contract request form per provider and submit with a current W9 for processing to mhtcontractrequest@Molinahealthcare.com. Thank you in advance have a wonderful day.        Thank You,     Sergio Delgado  Supervisor, Provider Contracts  Molina Healthcare of Texas, Inc.  1660 Westridge Circle N  Irving, TX 75038  Sergio.delgado@molinahealthcare.com', NULL, NULL, '2021-07-14 09:22:43', '2021-07-14 09:22:43'),
(36284, 11056, 28413, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning Sergio !  Hope you are doing well . There is no need for any apology. Here are the contract request forms with current W9 of the below mentioned providers for the following group again. Kindly see the attachments.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720  If you need any information or documents regarding enrollment feel free to call or email me. Eagerly, waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 06:48:29', '2021-07-20 06:48:29'),
(36285, 11056, 28413, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning Sergio !  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Kindly update me about it and the contract request forms which we have submitted on 14th July, 2021 to you.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me. Eagerly, waiting to hear from you soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-07-28 10:51:49', '2021-07-28 10:51:49'),
(36286, 11056, 28413, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email received from : MHTContractrequest@molinahealthcare.com  Sub  : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning,  Based on the email below I see both providers are in the process of credentialing. Please contact your coordinator for further assistance- Thank you!     HARRIS  Michele Thomas Martin    Michele.Thomas-Martin@MolinaHealthcare.com   888-562-5442 x200042        Norma Hong  MHT|Provider Contracts  1660 Westridge Cir. N Irving, TX 75038', NULL, NULL, '2021-08-03 10:29:22', '2021-08-03 10:29:22'),
(36287, 11056, 28413, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning Thomas!  Hope you are doing well. Please provide me the updates of my credentialing applications of the practice and providers mentioned below:   Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me. Eagerly, waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-09 15:29:30', '2021-08-09 15:29:30'),
(36288, 11056, 28413, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email received from  :  Michele.Thomas-Martin@molinahealthcare.com  Sub  :  Enrollment Status Update Needed - LHC - Molina Marketplace  Good Afternoon,  Thank you for your inquiry.  Please see the status for each provider listed below.  Oladipo Dada – The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.  Atinuke Dada - The request has been sent to credentialing for processing, please allow 3-4 weeks for processing.  Thank You, Michele Thomas-Martin Associate Specialist, Provider Contracts  1-888-562-5442 Ext. 200042 www.MolinaHealthcare.com Your Extended Family', NULL, NULL, '2021-08-16 08:23:15', '2021-08-16 08:23:15'),
(36289, 11056, 28413, NULL, '2021-08-30 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning Michele!  Hope you are doing well. Ok, Please keep me updated with future progress of the credentialing requests .  If you need any information or documents feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-23 10:04:49', '2021-08-23 10:04:49'),
(36290, 11056, 28413, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good morning Michele!  Hope you are doing well. It is just a follow-up email to inquire about enrollment status of the following providers and Practice. Please provide us with the latest updates soon.  Practice Details: Practice Name: Ladot Healthcare LLC Practice  NPI # : 1912502626 Practice  TIN # : 85-2432283  Providers Details: Provider Name : Dada, Atinuke Provider NPI# : 1154782720  Provider Name : Dada, Oladipo Provider NPI# : 1154782720   If you need any information or documents regarding enrollment feel free to call or email me. Eagerly, waiting to hear from you soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-01 09:48:30', '2021-09-01 09:48:30'),
(36291, 11056, 28413, NULL, '2021-09-20 00:00:00.000', 'In Process', 'Email sent to : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning Michele!  Hope this email finds you well. Please let this not take so long. Kindly keep me updated and May this be completed instantly.  If you need any information or documents please let me know. Please don\'t hesitate to reach out to me.  Thank you! Have a great week ahead!', NULL, NULL, '2021-09-13 10:56:00', '2021-09-13 10:56:00'),
(36292, 11056, 28413, NULL, '2021-09-30 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace  Good Morning,     Thank you for your inquiry.  Please see the status below for each provider.     Record # 180028 – Oladipo Dada -  The request is under the final process.  The request has been sent for loading in the billing system and should be complete by 10/1/21.     Record # 180265 – Atinuke Dada -The credentialing application still in process.  Please allow more time for processing.  Submitted an email to credentialing for status.', NULL, NULL, '2021-09-23 12:03:21', '2021-09-23 12:03:21'),
(36293, 11056, 28413, NULL, '2021-10-07 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace   Good Morning,  Thank you for your inquiry.   Please see the status updates for each record below.   180265 – Atinuke Dada – The request under credentialing, please allow a few more weeks for the credentialing application to process.', NULL, NULL, '2021-09-30 16:30:14', '2021-09-30 16:30:14'),
(36294, 11056, 28413, NULL, '2021-10-13 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : Enrollment Status Update Needed - LHC - Molina Marketplace   Good Morning,  Thank you for your inquiry.  Please see the status below for each provider.  Record # 180265 – Atinuke Dada -The credentialing application still in process.  Please allow more time for processing.  Submitted an email to credentialing for status.', NULL, NULL, '2021-10-06 09:02:18', '2021-10-06 09:02:18'),
(36295, 11056, 28413, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Afternoon,     Thank you for your inquiry.  The request for both providers have been sent for loading in the billing system.  Please follow up  after 10/15/21 for Atinuke Dada.', NULL, NULL, '2021-10-14 14:26:47', '2021-10-14 14:26:47'),
(36296, 11056, 28413, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email sent to: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good morning!  Hope you are doing great. Please provide me with latest updates on the following provider credentialing application.  Group Name	Ladot Healthcare LLC Tax ID	85-2432283 Group NPI	1912502626 Primary Location	2577 Madison Avenue, League City , TX 77573 Provider Name	NPI Atinuke Dada  	1154782720   If the credentialing and loading in the billing system has been completed, kindly do provide us with the welcome letter soon.  Thank you! Take Care!', NULL, NULL, '2021-10-21 15:38:14', '2021-10-21 15:38:14'),
(36297, 11056, 28413, NULL, '2021-11-19 00:00:00.000', 'Approved', 'Email received from: Michele.Thomas-Martin@molinahealthcare.com  Sub : RE: Enrollment Status Update Needed - LHC - Molina Health # 180028-180265  Good Morning,   Thank you for your inquiry.   The provider has been loaded in the billing system effective 10/15/21 under all plans.  The group contract includes all plans including Marketplace.   The providers have been added under all plans ( Medicaid, Medicare, Dual MMP and Marketplace)  There is no welcome letter for the group only the providers.  The welcome letters for the providers have already been sent.', NULL, NULL, '2021-11-12 15:17:36', '2021-11-12 15:17:36'),
(36298, 3040, 28414, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-05 14:36:57', '2021-05-05 14:36:57'),
(36299, 3040, 28414, NULL, '2021-05-12 00:00:00.000', 'In Process', 'Email sent to: michal.simms@christushealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || 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 Ladot Healthcare LLC.   Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Practice Address: 2577 Madison Avenue League City , TX 77573  Provider 1: Provider Name: Dada, Oladipo Provider NPI# 1760700223  Provider 2:   Provider Name: Dada, Atinuke Provider NPI# 1154782720  If you need any additional information please let me know. Waiting for your response.   Thank you', NULL, NULL, '2021-05-05 14:55:25', '2021-05-05 14:55:25'),
(36300, 3040, 28414, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: christus.hp.credentialing@christushealth.org Subject: Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Greetings,   Please find the attached Prospective Provider form as per your previous email requested for participating in the US family health plan.   If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 07:56:15', '2021-05-06 07:56:15'),
(36301, 3040, 28414, NULL, '2021-06-01 00:00:00.000', 'In Process', 'Email sent to: hunter.barrett@christushealth.org  Subject: Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || CHRISTUS HEALTH PLAN ||  Greetings,   Please find the attached revised Prospective Provider Form for participating in the US family health plan.  Thanks you  ', NULL, NULL, '2021-05-25 13:54:52', '2021-05-25 13:54:52'),
(36302, 1006, 28414, NULL, '2021-06-18 00:00:00.000', 'In Process', 'Sent f/u email @ Hunter Barrett hunter.barrett@christushealth.org:  Sub: Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || CHRISTUS HEALTH PLAN ||  \"Hello Hunter,   I hope you\'re doing well, I wanted to follow up with you on the status of this request. Please get back to me as soon as you\'re able to.   Thank you. \"', NULL, NULL, '2021-06-11 11:56:35', '2021-06-11 11:56:35'),
(36303, 1006, 28414, NULL, '2021-07-07 00:00:00.000', 'In Process', 'Email received from: hunter.barrett@christushealth.org  Sub : Enroll Group & Providers || Ladot Healthcare LLC || Group & Providers || CHRISTUS HEALTH PLAN ||  We still need the Admitting Hospital information in order to determine if a contract can be signed.     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, '2021-06-30 13:42:12', '2021-06-30 13:42:12'),
(36304, 11056, 28414, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org   Sub : Admitting Hospital Information - LHC - Christus Health Plan  Good morning Hunter,  Hope you are well. Here is the information of Admitting Hospital of Ladot Healthcare LLC of Christus Health Plan which you have requested for.  Hospital Details : Hospital Name : Bayshore Medical Center Hospital  Address  : 3801 Vista Rd, Pasadena, TX 77504 Hospital  Phone # : (713) 359-2000  If you further need any information regarding this kindly let me know. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-12 09:07:02', '2021-07-12 09:07:02'),
(36305, 11056, 28414, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : Enrollment Status - LHC - CHRISTUS HEALTH PLAN  Good morning,  Hope you are doing well. This is just a follow-up email about the enrollment process of the following providers under the below mentioned practice. Kindly keep me updated with the request . And if you need any information or documents please let me know.  Practice Details: Practice Name: Ladot Healthcare LLC Practice Tax ID# 85-2432283 Practice NPI# 1912502626 Address: 2577 Madison Avenue League City, TX 77573  Providers: Provider Name: Dada, Atinuke Provider NPI# 1154782720  Provider Name: Dada, Oladipo Provider NPI# 1760700223  Eagerly waiting to hear from you soon. Feel free to reach out to me for any queries.   Thank you! Have a great day!', NULL, NULL, '2021-07-19 10:30:16', '2021-07-19 10:30:16'),
(36306, 11056, 28414, NULL, '2021-07-30 00:00:00.000', 'Not Eligible', 'Email received from : hunter.barrett@christushealth.org  Sub : Enrollment Status - LHC - CHRISTUS HEALTH PLAN  We require providers to have admitting privileges at an in network hospital. If the provider does not we cannot accept the provider into the USFHP network. Unfortunately, at this time that is a requirement to join.  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, '2021-07-23 12:55:12', '2021-07-23 12:55:12'),
(36307, 1006, 28415, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36308, 1006, 28415, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'An enrollment request has been submitted via BCBS online enrollment:  \"Contact Us For status or if you have questions regarding your submission please email: TXProviderUpdateSubmission@bcbstx.com\"', NULL, NULL, '2021-05-12 09:01:24', '2021-05-12 09:01:24'),
(36309, 3040, 28415, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: TXProviderUpdateSubmission@bcbstx.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || BCBS ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  If you need any additional information please feel free to call or email me. Waiting for your response.   Thank you  ', NULL, NULL, '2021-06-09 13:48:16', '2021-06-09 13:48:16'),
(36310, 11056, 28415, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to : AncillaryContracting_SE@bcbstx.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic - BCBS || : Case Number - 02536362  Greetings,    Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.    Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612   If you need any additional information please feel free to call or email me. Waiting for your response.    Thank you!', NULL, NULL, '2021-06-28 13:21:52', '2021-06-28 13:21:52'),
(36311, 11056, 28415, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : AncillaryContracting_SE@bcbstx.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic - BCBS || : Case Number - 02536362  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location. Kindly update us by the enrollment status of our provider soon .  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612   If you need any additional information please feel free to call or email me. Waiting for your response.    Thank you!', NULL, NULL, '2021-07-12 16:29:17', '2021-07-12 16:29:17'),
(36312, 11056, 28415, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : AncillaryContracting_SE@bcbstx.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic - BCBS || : Case Number - 02536362  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location. Kindly update us by the enrollment status of our provider soon .  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612   If you need any additional information please feel free to call or email me. Waiting for your response.    Thank you!', NULL, NULL, '2021-07-19 15:00:36', '2021-07-19 15:00:36'),
(36313, 11056, 28415, NULL, '2021-08-02 00:00:00.000', 'In Process', 'I had words with some anonymous person. He/she informed me that provider is in credentialing process. The Provider ID is 8PN906.', NULL, NULL, '2021-07-26 13:03:57', '2021-07-26 13:03:57'),
(36314, 11056, 28415, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to : AncillaryContracting_SE@bcbstx.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic - BCBS || : Case Number - 02536362  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location. Kindly update us by the enrollment status of our provider soon .  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612   If you need any additional information please feel free to call or email me. Waiting for your response.    Thank you!', NULL, NULL, '2021-08-03 13:48:26', '2021-08-03 13:48:26'),
(36315, 11056, 28415, NULL, '2021-08-13 00:00:00.000', 'Approved', 'Approval Email received from : txintaketeampiermailbox@bcbstx.com  Sub : BCBSTX New Provider Information  Group Name : BEST HEALTH URGENT CARE & CLINIC Group Record Id : H000ND4301  Provider Name : SHAMETRIA TANN Provider Record Number : H08PN90601 Specialty : ANP/CERT/CLNP  We\'re glad you joined the Blue Cross and Blue Shield of Texas (BCBSTX) network. Our Provider website is full of information to make it easier for you to do business with us. You\'ll find everything from the latest news and updates, provider manuals, tools and options that can help streamline your administrative processes. Be sure to bookmark our site for easy reference. To help you get started, we\'ve listed the top 5 things you need to know  Eff date is : 08/06/2021  Welcome Letter is attached. Please see the attachment', NULL, NULL, '2021-08-06 10:30:33', '2021-08-06 10:30:33'),
(36316, 1006, 28416, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36317, 1006, 28416, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'The request has been submitted online via Aetna\'s website, attached form for reference. ', NULL, NULL, '2021-05-12 08:12:05', '2021-05-12 08:12:05'),
(36318, 1006, 28416, NULL, '2021-05-28 00:00:00.000', 'In Process', 'We received the following contract from Sylvia Machado-Petry Machado-petrys@aetna.com:  Sub: Sylvia Machado-Petry Has Sent You TX03_IND_MidLevelProvider_85%AMFS-AMMFS_ Shametria Tann, NP to Sign  \"Dear Health Care Professional/Administrator:  Your document, TX03_IND_MidLevelProvider_85%AMFS-AMMFS_ Shametria Tann, NP is attached. We know that the health, safety and well-being of your patients is a top priority. And we’re committed to joining you in providing a clear path to care.\"  Signed and sent back. ', NULL, NULL, '2021-05-17 08:55:54', '2021-05-17 08:55:54'),
(36319, 3040, 28416, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Cris) Aetna representative and she said the provider application is still in process for credentialing.   Ref:  6023736843', NULL, NULL, '2021-06-09 13:36:23', '2021-06-09 13:36:23'),
(36320, 11056, 28416, NULL, '2021-07-06 00:00:00.000', 'In Process', 'I had a word with (Maru) Aetna representative and she said the provider application is still in process for credentialing.  The application process takes 60 days. It might be completed in the mid of July. Ref : 6027427468', NULL, NULL, '2021-06-28 15:53:23', '2021-06-28 15:53:23'),
(36321, 1006, 28416, NULL, '2021-07-16 00:00:00.000', 'Approved', 'Hi Shametria Tann,  Welcome to the provider network effective Aug 1 2021 12:00AM.  Your Provider Identification Number (PIN) is: 6420946.  ', NULL, NULL, '2021-07-09 13:20:46', '2021-07-09 13:20:46'),
(36322, 1006, 28417, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36323, 1006, 28417, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'The enrollment request has been intiated via call and it should take upto 90~120 business days for processing.  Application# 12597496  Ref# Ana P 05-12-2021 ', NULL, NULL, '2021-05-12 08:43:09', '2021-05-12 08:43:09'),
(36324, 3040, 28417, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (GG) with Cigna representative and she said the contract decision department send the contract on May-13 and we couldn\'t received the contract. So she send the request to contract department to resend the contract.   Ref: GG 06/09/2021 ', NULL, NULL, '2021-06-09 14:13:35', '2021-06-09 14:13:35'),
(36325, 11056, 28417, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to :  intake_pdm@cigna.com   Sub : Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Good morning!  Hope you are doing well. Could you Please let me know the current status of Credentialing.I have mentioned the details below.  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Provider : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information.   Thank You!', NULL, NULL, '2021-06-28 12:14:02', '2021-06-28 12:14:02'),
(36326, 11056, 28417, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email received from : 9PSSCENT@cigna.com   & intake_pdm@cigna.com  Sub : Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  The credentialing process typically takes 60 to 90 days to complete.  However, we are experiencing a higher than normal volume of credentialing request, which may result in some delays in processing your application.  We will do our best to process your application as soon as possible.  You will receive an email once you have been approved and credentialed as a network-participating provider with your effective date, or to notify you that you have not been approved.   Thank you.', NULL, NULL, '2021-07-12 16:41:09', '2021-07-12 16:41:09'),
(36327, 11056, 28417, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to  : intake_pdm@cigna.com  Sub :  Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Good evening!  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Providers : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information. Waiting to hear from you soon.   Thank You!', NULL, NULL, '2021-07-19 12:51:56', '2021-07-19 12:51:56'),
(36328, 11056, 28417, NULL, '2021-08-04 00:00:00.000', 'In Process', 'Email received from : 	PDMCOGZ@cigna.com  Sub  : FW: [External] Credentialing Status Request- CIGNA - BEST HEALTH URGENT CARE & CLINIC  Hi Team,     Kindly handle this request.  Work id - W202107121793247  NPI-1780192633  NPI-1124615612     \"We have forwarded your request to the Providers Service Unit which is the correct department for proper handling.  For all future status request please submit directly to PSSCentral@Cigna.com.\"', NULL, NULL, '2021-07-28 11:41:59', '2021-07-28 11:41:59'),
(36329, 11056, 28417, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : PSSCentral@cigna.com  Sub : Credentialing Status Request- CIGNA - BHUCC  Good evening!  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Providers : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information. Waiting to hear from you soon.   Thank You! Have a great day!', NULL, NULL, '2021-08-03 15:30:53', '2021-08-03 15:30:53'),
(36330, 11056, 28417, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to :   PSSCentral@cigna.com   &   DiscoverCigna@information.cigna.com  Sub :   Good evening!  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Providers : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information. Waiting to hear from you soon.   Thank You! Have a great day!', NULL, NULL, '2021-08-10 09:42:16', '2021-08-10 09:42:16'),
(36331, 11056, 28417, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to :   PSSCentral@cigna.com   &   DiscoverCigna@information.cigna.com  Sub :   Good evening!  Hope you are doing well. Could you Please let me know the current status of our Credentialing request and inform us as soon as possible.I have mentioned the details below of our group and providers :  Practice:   Practice Name : Best Health Urgent Care & Clinic Practice TIN # : 84-4737737 Practice  NPI# :1013540962  Providers : Provider Name : Stephane Cyriaque Provider NPI: 1780192633  Provider Name : Tann, Shametria Provider NPI: 1124615612    Do let me know if you need any information. Waiting to hear from you soon.   Thank You! Have a great day!', NULL, NULL, '2021-08-16 17:08:26', '2021-08-16 17:08:26'),
(36332, 11056, 28417, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : JENNIFER.PEREZ@cigna.com  Sub : Enrollment Status Query - BHUCC - Cigna Healthspring  HI Ahmed,     I’m unsure if you received my previous message, however in order to enroll in Cigna-Medicare we would need the following form filled out. We would need this for Nasa Health Clinic, Nasa Urgent Clinic and BHUCC.        Thank you,', NULL, NULL, '2021-08-23 14:32:48', '2021-08-23 14:32:48'),
(36333, 11056, 28417, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : Michele.Wasson@cigna.com  Sub : SHAMETRIA TANN NP - PARTICIPATION REQUEST  Hello,     Thank you for your credentialing request.  Upon review, verification of hospital privileges is needed. The requirement selected below must be met per the specialty requested:     __x__Provider must have their own active admitting privileges at a Cigna participating hospital or…  Provider has an arrangement with a Cigna participating provider that will admit on their behalf to a Cigna participating hospital or…  Provider has an arrangement with a Hospitalist group to admit on their behalf at a Cigna participating hospital.        ____Provider must have their own active admitting privileges at a Cigna participating hospital, birthing center or surgery center.           Please complete and return the attached verification form to my attention so that further processing of the application can continue.      Thank you     ConnectedCare PROVIDER OPERATIONS  Michele Wasson  Network Solutions & Operations | Provider Services Senior Analyst  Fax 855.757.9700     “Don’t let circumstances or situations define your life.  Use your sweat equity” – Inky Johnson', NULL, NULL, '2021-08-31 09:05:18', '2021-08-31 09:05:18'),
(36334, 11056, 28417, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : Michele.Wasson@cigna.com  Sub : SHAMETRIA TANN NP - PARTICIPATION REQUEST  Hello,     Thank you for your credentialing request.  Upon review, verification of hospital privileges is needed. The requirement selected below must be met per the specialty requested:     __x__Provider must have their own active admitting privileges at a Cigna participating hospital or…  Provider has an arrangement with a Cigna participating provider that will admit on their behalf to a Cigna participating hospital or…  Provider has an arrangement with a Hospitalist group to admit on their behalf at a Cigna participating hospital.        ____Provider must have their own active admitting privileges at a Cigna participating hospital, birthing center or surgery center.           Please complete and return the attached verification form to my attention so that further processing of the application can continue.      Thank you     ConnectedCare PROVIDER OPERATIONS  Michele Wasson  Network Solutions & Operations | Provider Services Senior Analyst  Fax 855.757.9700     “Don’t let circumstances or situations define your life.  Use your sweat equity” – Inky Johnson', NULL, NULL, '2021-08-31 09:05:18', '2021-08-31 09:05:18'),
(36335, 11056, 28417, NULL, '2021-09-09 00:00:00.000', 'In Process', 'Email received from : michele.wasson@cigna.com &  DiscoverCigna@information.cigna.com  Sub : Cigna Credentialing Status Update: Application Received  Re:	Reference number 12729352 for SHAMETRIA TANN, NP Application to participate in the Cigna medical network Dear BRAD PETERSON,  Thank you for submitting an application for one of your providers to join a Cigna network. We have received your application and are in the process of reviewing it.  What happens next?  Once the application review is complete, we will begin the credentialing process. This usually takes 90 business days from the date we receive your completed application. In some states, individual mandates may affect turnaround time. We will contact you if there is any missing information.  Once the credentialing process is complete, we’ll let you know if you’ve been approved as a participating provider in the network(s) for which you\'ve applied.  Sincerely,  Cigna  1.800.882.4462  or email OnboardingStatus@Cigna.com.', NULL, NULL, '2021-09-02 10:42:52', '2021-09-02 10:42:52'),
(36336, 11056, 28417, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : 9PSSCENT@Cigna.com  Sub : FW: [External] Re: SHAMETRIA TANN NP - PARTICIPATION REQUEST  Hello,   Thank you for contacting Cigna.  Your application is currently in process and was received on 08/23/2021.  Your application reference number is BID 12729352   The credentialing process typically takes 60 business days to complete.  However, we are experiencing a higher than normal volume of credentialing request, which may result in some delays in processing your application. Currently, the process can take 90-120 days. We will do our best to process your application as soon as possible.  You will receive an email notification once you have been approved and credentialed as a network-participating provider with your effective date, or to notify you that you have not been approved.  If you have any additional questions, please contact the Provider Services Unit at 800.882.4462.    ConnectedCare PROVIDER OPERATIONS  Shayla Powell  Provider Service Unit | Provider Service Associate T: 1-800-882-4462', NULL, NULL, '2021-09-08 15:21:53', '2021-09-08 15:21:53'),
(36337, 11056, 28417, NULL, '2021-09-23 00:00:00.000', 'In Process', 'Email received from : 9PSSCENT@Cigna.com  Sub : RE: [External] Re: SHAMETRIA TANN NP - PARTICIPATION REQUEST  Hello,  Thank you for contacting Cigna Provider Service Unit according to our records we show that we received the application for SHAMETRIA TANN BID# 12597496 on 05/12/2021 and this closed on 06/27/2021 due to not receiving the contracts back. If you have questions or need any assistance please contact Cigna Provider Service Unit at 800-882-4462  Thank you,  Provider SOLUTIONS & OPERATIONS **Lynette W ** Provider Service Unit T: 800.882.4462', NULL, NULL, '2021-09-16 14:52:45', '2021-09-16 14:52:45'),
(36338, 11056, 28417, NULL, '2021-10-06 00:00:00.000', 'In Process', 'Rep : BIEGO V  Ref code : BIEGO9292021  Status: We have to provide an application again and they will start the credentialing process from the beginning again. It will take 90 -120 days from now.  There is no possiblity for re-opening the last application, but still trying.  medicalonboarding@cigna.com  contact no .: 800.882.4462', NULL, NULL, '2021-09-29 09:54:41', '2021-09-29 09:54:41'),
(36339, 11056, 28417, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Rep : Luis A  Status :  Have to sent email to @ intake_pdm@cigna.com with provider & practice details with w-9  Ref code : LuisA10052021   Email has been sent  ', NULL, NULL, '2021-10-05 12:26:20', '2021-10-05 12:26:20'),
(36340, 11056, 28417, NULL, '2021-10-21 00:00:00.000', 'Approved', 'Email received from :  Intake_PDM@cigna.com  Sub :  Completion Notification -- W202110051938464  Dear Health Care Professional,   We received your recent request, a copy of which is enclosed. This request has been completed.  If you have any questions, please send an email to Intake_PDM@cigna.com and include: • Cigna Internal Reference # (W202110051938464).  As per the source document the request has been completed eff date : 09/10/2021  Thanks, PDM Team  Confirmed on the call too. Rep : Manny P  Status : Particpating with Cigna. Linked to the TIN. We can bill now and can send claims on the provider   eff : 09/10/2021  Ref code : Mannyp10142021   Please see the attachment.', NULL, NULL, '2021-10-14 13:51:53', '2021-10-14 13:51:53'),
(36341, 1006, 28418, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36342, 1006, 28418, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Request for participating has been submitted via UHC online portal. Attached for reference.', NULL, NULL, '2021-05-12 12:16:23', '2021-05-12 12:16:23'),
(36343, 1006, 28418, NULL, '2021-05-25 00:00:00.000', 'In Process', 'We received the following update from UHC: \"5/17/2021  Shametria Tann bhucc@claimsmedinc.com  MPIN#: 7674348  Re: Update on your UnitedHealthcare Credentialing Application  Dear Shametria Tann:  Thank you for your interest in joining the UnitedHealthcare network. We received your request for participation and have good news: Credentialing is not required because you meet the following requirements:  Practice exclusively in an inpatient setting or a freestanding facility, and Only provide care for members at this facility. If our information is inaccurate, and you need to be credentialed for an outpatient practice, please let us know. Just email us at Networkhelp@uhc.com. . Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request and make sure to include that you practice in both inpatient and outpatient settings. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.  What happens next? We’ve automatically forwarded your request for participation to the contracting team. They’ll be in touch to follow up on your contract and any demographic updates that may be needed.  Questions? We\'re here to help. If you have any questions, please email us at Networkhelp@uhc.com. Include the health care professional’s full name, National Provider Identifier (NPI), Tax Identification Number (TIN) and brief description of the request. A UnitedHealthcare representative will be in touch with you within two business days from when we receive your request. To learn more about joining the UnitedHealthcare network and about each step in the process, go to UHCprovider.com/join.\"', NULL, NULL, '2021-05-18 08:47:05', '2021-05-18 08:47:05'),
(36344, 1006, 28418, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent f/u email to UHC regarding status. ', NULL, NULL, '2021-06-09 17:09:13', '2021-06-09 17:09:13'),
(36345, 11056, 28418, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Group Contract Request || Best Health Urgent Care & Clinic || UHC ||   Greetings,  Hope you are doing well. Could you please advise me if the group is eligible for the group contract as we have only one provider under the practice. Below are the practice details.  Practice: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any additional information please feel free to call or email me. Waiting to hear form you soon.  Thank you!', NULL, NULL, '2021-06-28 13:59:19', '2021-06-28 13:59:19'),
(36346, 11056, 28418, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : networkhelp@uhc.com  Sub : Enrollment Request - BHUCC - United HealthCare  Greetings,  Hope you are doing well. I wanted to enroll our group and provider mentioned below in United HealthCare. Kindly respond to me soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Providers: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-07-12 14:30:17', '2021-07-12 14:30:17');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(36347, 11056, 28418, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Hello,   Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed  TANN, SHAMETRIA  - 7674348 /TAX ID 844737737 regarding enrolling group and provider. Per your provider’s profile, I can confirm that group is enrolled, and the provider is linked to the group, waiting to be added to group contract. Open phycon add to group PR-5925454 being work on. Need more time to complete, 30 days.   Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com (link: mailto:networkhelp@uhc.com). Have a wonderful day!   Thank You,   Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:37:37', '2021-07-15 15:37:37'),
(36348, 11056, 28418, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Enrollment Request - BHUCC - United HealthCare  Good Morning,     Thank you for contacting the Network Management Resource Team. A provider has to first meet the criteria for credentialing before contracting can begin. In order to credential this provider, please first make sure that the provider\'s CAQH application is up to date and has been attested. Next, submit this request electronically via the following hyperlink: https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html.      An OptumID will be required to access the credentialing tool. To register or view a guide, please go to UHCprovider.com/newuser. Should you need assistance in registering for an Optum ID or if you need assistance or status on updating your existing access, please contact the online/LINK help desk at (866)842-3278, option 1.     For assistance in provisioning your current Optum Login ID to access OnBoardPRO for this specific group/Tax ID, please see the attached quick reference guide on how to identify the group’s Tax ID password administrator.     For additional resources, please visit https://www.uhcprovider.com/en/resource-library/link-provider-self-service/onboard-pro.html?cid-none     Please let us know if we can assist further via email.        Thanks,  Keaira Johnson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:55:12', '2021-07-15 15:55:12'),
(36349, 11056, 28418, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for BEST HEALTH URGENT CARE & CLINIC*** - 7341276, and  TANN, SHAMETRIA  - 7674348.     Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1). Please let us know if we can assist further.     Thank you,     Aldean Mosley  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-27 12:37:10', '2021-07-27 12:37:10'),
(36350, 11056, 28418, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  SUB : Secure Message from keaira_johnson@uhc.com  Good Afternoon,  Thank you for contacting the Network Management Resource Team.  After further review, I show the group and provider are both loaded and associated with Practice Tax ID # : 84-4737737.  I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested. Additionally, if you are wanting the specific lines of business that the providers are linked to, this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.  If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).     In regards to adding a new practitioner to your existing Medical Group Participation Agreement.      There are two ways you can submit your request:  a.      For faster processing, submit a change request using our Link App called My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html).  This process will enable you to check your status online. If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).  b.      If you don’t have access to My Practice Profile, then complete the attached form for each practitioner and send via email to hpdemo@uhc.com.   You should receive a reference number (starts with PR) for your request within an hour. If you have not received a PR number within 24 business hours (please double check spam/junk folder), please resubmit due to technical error. Please do not CC anyone on your request. This can cause an error and it may not be received.     Please let us know if we can assist further via email.        Thanks,  Keaira Johnson  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-28 17:39:34', '2021-07-28 17:39:34'),
(36351, 11056, 28418, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : Secure Message from robin_joplin@uhc.com  Good Afternoon,  Thank you for contacting the Network Management Resource Team.   Both providers are linked to the group contract.  Please let us know if we can be of further assistance.  Thank you.  Robin Joplin UnitedHealthcare Network Management Resource Team (NMRT)  Our United Culture. The way forward.  â–  Integrity â–  Compassion â–  Relationships â–  Innovation â–  Performance', NULL, NULL, '2021-07-29 16:33:42', '2021-07-29 16:33:42'),
(36352, 11056, 28418, NULL, '2021-08-17 00:00:00.000', 'Approved', 'Thank you for contacting the Network Management Resource Team. We will be glad to assist regarding your inquiry. I have included the product roster showing the demographic information, lines of business, and effective dates for the providers requested.      Additionally, if you are wanting the specific lines of business that the providers are linked to this information is now in your LINK/My Practice Profile (https://www.uhcprovider.com/en/demographics-profiles-attestation/link-my-practice-profile.html). Please see the attached handout for more information.    If you have further questions regarding this system, please feel free to contact the LINK help desk (866-842-3278, option 1).    Please let us know if we can assist further.   Sue Isaacson  UnitedHealthcare  Network Management Resource Team (NMRT)   Eff date is  :  07/10/2020', NULL, NULL, '2021-08-09 17:05:07', '2021-08-09 17:05:07'),
(36353, 1006, 28419, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36354, 1006, 28419, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Currently, TCHP enrollment is on hold because we need to have a supervising physician enrolled to proceed, sent f/u email to Stephane regarding this:  \"Hello Stephane,  I hope you\'re doing well, I just wanted to check in with you if you had any luck getting in touch with Dr. Segun regarding what we discussed in regards to enrollment with TCHP? As he will also need to be enrolled with TCHP under BHUCC.   Thank you. \"', NULL, NULL, '2021-06-07 15:05:40', '2021-06-07 15:05:40'),
(36355, 11056, 28419, NULL, '2021-07-22 00:00:00.000', 'On Hold', 'Confirmation received from the Provider. Now initiating his Medicare and after the Medicare we will work soon on this too!', NULL, NULL, '2021-07-14 16:06:46', '2021-07-14 16:06:46'),
(36356, 11056, 28419, NULL, '2021-09-17 00:00:00.000', 'On Hold', 'Email received from : neruiz@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Thank you for the clarification Brad.     Looking into the physicians credentials more in-depth, we show she is no longer attested with the group through TCHP and is showing as excluded. We need both the Supervising Physician and NP attested to the group (Best Health Urgent Care & Clinic )under TCHP.     Please follow up with the health plan to get this information updated. Once updated, please submit a new Letter of Interest for both physicians. We are unable to move the process forward under the current request as is.     To update: call TMHP 800-925-9126 opt 3 or go online https://www.tmhp.com/  Waiting for the response of Mr. Segun. To be the Supervising physician for the group in this plan.', NULL, NULL, '2021-09-10 11:59:58', '2021-09-10 11:59:58'),
(36357, 11056, 28419, NULL, '2021-09-21 00:00:00.000', 'Initiated', 'Email sent to : TCHPnetworkmanagement@texaschildren.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning!  Hope all is well. We want to enroll the providers and practice with the Texas Children Health Plan. We do have the Supervising Physician now for the group. Please assist us as soon as possible   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Adeoye, Segun          Supervising Physician Provider NPI# : 1629418025  Provider Name : Tann, Shametria         FNP Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane    FNP Provider NPI# : 1780192633   If you need any additional information please feel free to call or email me. Waiting for your response.  Thank you! Have a Blessed Day!', NULL, NULL, '2021-09-14 10:05:36', '2021-09-14 10:05:36'),
(36358, 11056, 28419, NULL, '2021-10-04 00:00:00.000', 'In Process', 'Email sent to : 	TCHPnetworkmanagement@texaschildren.org Join TCHP jointchp@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract   Good morning!  Hope you had a great and safe weekend. I am still waiting to get assistance on enrolling the below mentioned providers and practice with TCHP. But no one haven\'t responded to my query yet.   Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Stephane Cyriaque (FNP)	1780192633 Shametria Tann  (FNP)	1124615612 Segun Adeoye (Supervising Physician)	1629418025  Please do not hesitate to contact me directly, if you have any questions or concerns I am happy to help.  Thank you! Have a great day!', NULL, NULL, '2021-09-27 10:01:55', '2021-09-27 10:01:55'),
(36359, 11056, 28419, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email received from :bxgupta@texaschildrens.org  Sub : Fwd: TCHP-Best Health Urgent Care & Clinic Contract  Good morning Mr.Talha,  Provider Details:  Provider Name : Adeoye, Segun          Supervising Physician-  has been PAR since 2019 Provider NPI# : 1629418025   The 2 NP you wanted to add? I see the email chain that you have been in communication with her but she is no longer works here. If you want to add np to the group and if they are attested to TMHP then please send Provider information form along with W9 and I will have them process. If you have any other concerns please do not hesitate to call me @832-877-3506 or 832-828-1219. Please see attached PIF.   Thank you & have  grreat day!', NULL, NULL, '2021-10-05 08:53:45', '2021-10-05 08:53:45'),
(36360, 11056, 28419, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Hello Ahmed,  I am a contract administrator with Texas Children’s Health Plan. I am working on your contract. Can you please provide me with a roster of the practitioners in your group practice? You can use the attached spreadsheet and return to me. The providers will be listed as an Exhibit to the contract.  Thank you,', NULL, NULL, '2021-10-21 14:41:28', '2021-10-21 14:41:28'),
(36361, 11056, 28419, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email received from : mdfouts@texaschildrens.org  Sub : Please DocuSign: AGMT_BEST HEALTH URGENT CARE & CLINIC, PLLC.pdf  Agreement has been signed ', NULL, NULL, '2021-10-21 16:58:21', '2021-10-21 16:58:21'),
(36362, 11056, 28419, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good afternoon Melissa!  Hope this email finds you well. Please find the roster of the practitioners in the practice in the attachments.  Furthermore, If you need any additional information or documents feel free to reach out to me, I will be happy to assist you.  Thank you! Take Care!', NULL, NULL, '2021-11-01 10:39:01', '2021-11-01 10:39:01'),
(36363, 11056, 28419, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Email received from: mdfouts@texaschildrens.org  Sub : Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC   Hello Talha,  Texas Children’s Health Plan’s Provider Information Form is the form needed to get the providers through our contracting and credentialing phases. I already have the PIF for Stephane but will need the form completed for  Shemetria and Segun. If you have submitted them previously, you can send them to me but ensure that today’s date is on the form so we don’t see it as a duplicate.     I’ll sent the contract over to Stephane just a few minutes ago.     The PIF is linked here if you need it.  https://www.texaschildrenshealthplan.org/sites/default/files/pdf/ND-2011-347%20Provider%20Information%20Form_2021_Fillable_update%2004.21.pdf     Thanks,  Melissa  Forms has been submitted and attached.', NULL, NULL, '2021-11-12 17:33:42', '2021-11-12 17:33:42'),
(36364, 11056, 28419, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Sub:  Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Thank you. Your providers have been sent over to our credentialing department. Once they have cleared, I’ll send the contract to our president for execution and an effective date can be assigned at that time.     Thank you for your quick responses. Happy Friday!', NULL, NULL, '2021-11-29 13:53:03', '2021-11-29 13:53:03'),
(36365, 11056, 28419, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  mdfouts@texaschildrens.org  Sub:  Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Thank you. Your providers have been sent over to our credentialing department. Once they have cleared, I’ll send the contract to our president for execution and an effective date can be assigned at that time.     Thank you for your quick responses. Happy Friday!', NULL, NULL, '2021-11-29 13:53:03', '2021-11-29 13:53:03'),
(36366, 11056, 28419, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good morning Melissa!  Hope you had a great weekend. Kindly, provide me with the latest updates on the process of credentialing. Please also let me know about the execution of the contract and assigning of the effective dates.  Please respond to my query at your earliest convenience.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-08 17:14:16', '2021-12-08 17:14:16'),
(36367, 11056, 28419, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good morning Melissa!  Hope you had a great weekend. Kindly, provide me with the latest updates on the process of credentialing. Please also let me know about the execution of the contract and assigning of the effective dates.  Please respond to my query at your earliest convenience.   Thank you! Have a wonderful day!', NULL, NULL, '2021-12-08 17:14:17', '2021-12-08 17:14:17'),
(36368, 11056, 28419, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC  Good evening Melissa!  Hope you are having a wonderful day. Any updates on the credentialing applications? What about the execution of the contract and assigning of the effective dates?  Please get back to me as soon as possible.  Thank you! Have a great day!', NULL, NULL, '2021-12-17 10:34:25', '2021-12-17 10:34:25'),
(36369, 11056, 28419, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: mdfouts@texaschildrens.org  Sub: Texas Children\'s Health Plan - Best Health Urgent Care & Clinic, PLLC   Shametria Tann has not cleared credentialing so no effective date as of yet.', NULL, NULL, '2021-12-23 10:48:43', '2021-12-23 10:48:43'),
(36370, 19067, 28419, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: Enrollment Query || BHUCC || Shametria Tann || TCHP ||   Good Morning!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 Texas Pkwy Unit B, Missouri City, TX 77489-5242 Provider Name	NPI Shametria Tann	1124615612   Thanks & Regards, Hammad Ahmed. ', NULL, NULL, '2022-01-04 10:09:48', '2022-01-04 10:09:48'),
(36371, 19067, 28419, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email received from: mdfouts@texaschildrens.org  Subject: Enrollment Query || BHUCC || Shametria Tann || TCHP ||    Hello Hammad,  Shametria Tann has not cleared credentialing as of yet. She is still in the process.     Melissa', NULL, NULL, '2022-01-09 19:21:15', '2022-01-09 19:21:15'),
(36372, 19067, 28419, NULL, '2022-01-28 00:00:00.000', 'In Process', 'Email sent to: mdfouts@texaschildrens.org  Subject: Re: Enrollment Query || BHUCC || Shametria Tann || TCHP ||  Greetings!  Can you please advise how much time it will take to get the process cleared?  Regards. Hammad.', NULL, NULL, '2022-01-20 20:19:49', '2022-01-20 20:19:49'),
(36373, 1019, 28419, NULL, '2022-02-09 00:00:00.000', 'Approved', 'Received the following email from bxgupta@texaschildrens.org  Sub: Welcome letter - Shametria Tann, FNP  Greetings,         Welcome to TCHP Shametria Tann, FNP is now participating with Texas Children’s Health Plan under Best Health Urgent Care & Clinic, group. Attached you will find a welcome letter with effective dates for all contracted products as well as the contact information for your Provider Relations Representative. Please reach out to your PR Rep or the Contracting Department phone line at (832) 828-1004 with any questions.         Thank you and have a great day!   ​  Respectfully,     cid:image003.png@01D80DEF.1150EA50              Bharvi Gupta  Contract Specialist  6330 West Loop South  Bellaire, Texas 77401  bxgupta@texaschildrens.org         ___________________________________________', NULL, NULL, '2022-02-02 12:24:30', '2022-02-02 12:24:30'),
(36374, 1006, 28420, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36375, 1006, 28420, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Sent an initiation email @ HumanaHoustonPD humanahoustonpd@humana.com:  Sub: Provider Roster - Shametria Tann - BHUCC  \"Hello,   Please find the attached provider roster to enroll and add the given provider in our group, please let me know what the expected time frame is for this to be completed, and do not hesitate to reach out to me for any missing information.  Thank you. \"  Roster attached for reference. ', NULL, NULL, '2021-05-12 10:33:35', '2021-05-12 10:33:35'),
(36376, 3040, 28420, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: humanahoustonpd@humana.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Humana ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  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 14:53:54', '2021-06-09 14:53:54'),
(36377, 11056, 28420, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Humana ||  Greetings,  Hope you are doing well. Kindly provide us the welcome letter or the contract as soon as possible. We\'ll be waiting for that eagerly.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242    Provider Details:  Provider Name: Tann, Shametria Provider NPI# 1124615612  Thank you!', NULL, NULL, '2021-06-28 12:28:11', '2021-06-28 12:28:11'),
(36378, 11056, 28420, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Humana ||  Please read the following instructions carefully:  For the following requests (fee schedules, copies of contracts, network participation, credentialing status, or effective dates) call provider relations at 800-448-6262 or 800-626-2741. All maintenance requests (provider adds, terms and changes)  need to be sent through Humanahoustonpd@humana.com.  Note:  This mailbox is only for these intents (adds, terms, changes). Requests for fee schedules, copies of contracts, network participation, credentialing status, or effective dates will not be processed through this mailbox.  Allow 60 days for processing of new applicants submission. Allow 30 days for processing of terminations and demographic updates. Status requests should be sent on your original email submission for tracking purposes. Please do not send direct emails to associates as there may not be a response to your request, and the request will not be processed.  In addition, please do not cc a Humana associate on your email requests to the above mailbox or this may delay the processing of your request. Disputing a claim paid/denied and appeals: contact humanaproviderservices@humana.com Log on to Humana.com or Availity.com for Provider updates, claim inquiries, eligibility/benefits information, fee schedule inquiries and more! For Humana.com issues and password resets, please call a Humana Web Specialist at 877-845-3480.    Thank you,  HumanaHoustonPD', NULL, NULL, '2021-07-13 14:07:25', '2021-07-13 14:07:25'),
(36379, 11056, 28420, NULL, '2021-07-29 00:00:00.000', 'In Process', 'I had words with Aya A for the practice and provider\'s approval letter. She informed me by their policy that they don\'t provide the approval letter to the Specialty of Nurse Practitioner or not to the practice either for this specialty. But they are in network with Humana and par in Humana as HMO & PPO . The eff. date is  : 04/01/2021. Ref code : 2000193367970', NULL, NULL, '2021-07-22 13:09:00', '2021-07-22 13:09:00'),
(36380, 11056, 28420, NULL, '2021-08-03 00:00:00.000', 'In Process', 'I have words with Jayson about the approval again But she said the same as Aya A. There is no credentialing of NP. But she informed me the procedure related to showing up of the provider in the directory. The provider is linked with the Tax ID of practice and participating with Humana. Plans :     1. Humana HMO       2. Humana PPO      3. Medicare PPO     4.Choice care PPO Ref no. : 2000193784179  We have to sent a LOI with provider roster and W-9 at npxnm@humana.com', NULL, NULL, '2021-07-26 14:30:48', '2021-07-26 14:30:48'),
(36381, 11056, 28420, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : HumanaHoustonPD@humana.com  Sub : Enrollment Documents - BHUCC - Humana  Good evening!  Hope you are doing well. Here are the documents W-9 attached with LOI and providers rosters you requested for the practice / group enrollment mentioned below:  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  Furthermore, If you need any documents or information feel free to contact me. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-03 16:30:19', '2021-08-03 16:30:19'),
(36382, 11056, 28420, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Documents - BHUCC - Humana  Please advise who you spoke with.  You indicate this information was requested by this mailbox, yet I find no record of this request.  Both of these practitioners are already in the Humana system and linked to this TIN.', NULL, NULL, '2021-08-10 11:38:35', '2021-08-10 11:38:35'),
(36383, 11056, 28420, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to :   HumanaHoustonPD@humana.com  Sub : Enrollment Documents - BHUCC - Humana  Good morning!  Hope you are doing well. I had spoken to one of your representatives and She had advised me to send both providers\' roster and LOI for the facility approval  If both providers are in the Humana system and linked to the TIN, please provide us the approval letter for both providers with the effective date soon.  If you need any information or documents please feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-16 14:49:28', '2021-08-16 14:49:28'),
(36384, 11056, 28420, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : HumanaHoustonPD@humana.com  Sub : Enrollment Documents - BHUCC - Humana  Did you ask customer service for the approval letter?  We do not have access to them.   Replied :   Good morning!  Hope all is well. Yeah I asked about the approval letter because she informed me that credentialing of the provider is in the last stages. Please provide me with the latest updates soon.  If you need any information from me please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 14:45:50', '2021-08-23 14:45:50'),
(36385, 11056, 28420, NULL, '2021-09-07 00:00:00.000', 'Approved', 'Approval email received from : HumanaHoustonPD@humana.com  I have words with Nikki for confirmation of approval. She informed me that provider Shametria Tann is linked and loaded in the system.  We can bill on Shametria Tann under the Tax I.D of the practice. eff date : 5/28/2021  She is participating in plans are as followed:  Humana HMO  Humana PPO Choice care PPO Medicare PPO Medicare private c   I’m not sure they issued one for FNPs at the time because extenders were not fully credentialed  Please see the attachment .', NULL, NULL, '2021-08-30 16:48:36', '2021-08-30 16:48:36'),
(36386, 1006, 28421, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36387, 1006, 28421, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Sent enrollment request email @ TX Credentialing TXCredentialing@amerigroup.com:  Sub: Enrollment Query - BHUCC - Amerigroup  \"Hello,  I wanted to enroll the following provider under our group contract, the information is as follows: Group Name: Best Health Urgent Care & Clinic NPI# 1013540962TIN# 84-4737737 Provider Name: Tann, Shametria NPI# 1124615612 Please let me know what is required and get back to me as soon as you\'re able. \"', NULL, NULL, '2021-05-28 14:27:05', '2021-05-28 14:27:05'),
(36388, 3040, 28421, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to:  TXCredentialing@amerigroup.com  Subject: {EXTERNAL} Enrollment Query - BHUCC - Amerigroup  Hello,   This is going to be an urgent care clinic, but we wish to enroll the provider as a PCP as well. Is that a possibility? Thank you.', NULL, NULL, '2021-06-09 13:41:29', '2021-06-09 13:41:29'),
(36389, 11056, 28421, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to : TXCredentialing@amerigroup.com  Sub :  Enrollment Query - BHUCC - Amerigroup  Hello,   This is going to be an urgent care clinic, but we wish to enroll the provider as a PCP as well. Is that a possibility? Kindly respond as soon as possible.  Practice:    Practice Name: Best Health Urgent Care & Clinic NPI# : 1013540962  TIN# : 84-4737737    Provider :   Provider Name: Tann, Shametria NPI# 1124615612   Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-06-28 13:48:37', '2021-06-28 13:48:37'),
(36390, 11056, 28421, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : TXCredentialing@amerigroup.com  Sub : Enrollment Request - BHUCC - Amerigroup   Good evening,  This is going to be an urgent care clinic, but we wish to enroll the provider as a PCP as well. Is that a possibility? Kindly guide us the procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Provider : Provider Name: Tann, Shametria Provider  NPI # : 1124615612  If you need any documents or information feel free to reach out to us .Waiting to hear from you soon.  Thank you! Have a good day!', NULL, NULL, '2021-07-12 16:18:50', '2021-07-12 16:18:50'),
(36391, 11056, 28421, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : txcredentialing@amerigroup.com  Sub : Enrollment Request - BHUCC - Amerigroup  Hey,  Here are the filled forms with LOI, group application release form , Word Document for the Urgent Care & W9 of the Group & Providers mentioned below. Kindly see the attachments .  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information or documents please let me know.  Thank you!', NULL, NULL, '2021-07-13 13:10:11', '2021-07-13 13:10:11'),
(36392, 11056, 28421, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub : Enrollment Request - BHUCC - Amerigroup  Thank you, but there was no Word Document attached.  Email sent to  : txcredentialing@amerigroup.com  Greetings,   Hope you are doing well. The word document is attached in the PDF format in the form below . Kindly check the forms, If you don\'t find it, inform me. I\'ll  send it to you as a  word document as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612     Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633     If you need any further information or documents please let me know. Feel free to call or email me.     Thank you!  Have a great day!', NULL, NULL, '2021-07-22 13:18:01', '2021-07-22 13:18:01'),
(36393, 11056, 28421, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email received from : txcredentialing@amerigroup.com  Sub :  Enrollment Request - BHUCC - Amerigroup  We can do both.     Here is what we need to do.     1)      Complete an individual LOI for each of the practitioners providing services  2)      Complete the group application release form  3)      Complete the Word Document attached for the Urgent Care piece  4)      Complete and attach a w9     Thank you', NULL, NULL, '2021-07-29 08:54:47', '2021-07-29 08:54:47'),
(36394, 11056, 28421, NULL, '2021-08-10 00:00:00.000', 'In Process', 'Email sent to :  txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Enrollment Request - BHUCC - Amerigroup   Greetings,  Hope all is well. I wanted to inquire about the enrollment status of the provider and group. Kindly update me with the enrollment status of the below mentioned providers and group.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-03 13:42:49', '2021-08-03 13:42:49'),
(36395, 11056, 28421, NULL, '2021-08-13 00:00:00.000', 'Approved', 'Approval Email received from : txcredentialing@amerigroup.com  Sub : RE: {EXTERNAL} Enrollment Request - BHUCC - Amerigroup  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Best Care Urgent Care is loaded as a facility since it is an Urgent Care.  The facility has been in network since 05/13/2020.  ID # Practice Details:   Due to Ancillary contract Provider is directly approved. Eff. date is  :   05/13/2020', NULL, NULL, '2021-08-06 10:56:49', '2021-08-06 10:56:49'),
(36396, 1006, 28422, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36397, 1006, 28422, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request email @ providerrelationsinquiries@communityhealthchoice.org:  Sub: Enrollment Query - BHUCC - CHC  \"Hello,   I hope you\'re doing well, I wanted to verify if we need to separately enroll the following provider under our group, the information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962  Provider Name: Shametria Tann NPI# 1124615612  Also, our group isn\'t showing up on the provider directory please let me know what is required to get it to show up there.   Thank you. \"', NULL, NULL, '2021-06-07 15:19:59', '2021-06-07 15:19:59'),
(36398, 1006, 28422, NULL, '2021-06-30 00:00:00.000', 'In Process', 'We received the following response from Provider Relations Inquiries ProviderRelationsInquiries@communityhealthchoice.org:  Sub: Enrollment Query - BHUCC - CHC  \"Good Afternoon,  You’re inquiry regarding adding the provider under your group has been forwarded to our Contracting Department (CHC.Contracting@CommunityHealthChoice.org).  A request has been submitted to our Provider Database Department regarding the directory. The ID of your service record is 351776, we will provide a response soon.  Thank you, Provider Relations Dept.\"  Sent f/u email:  \"Hello Kris,  I wanted to verify if both our group and the mentioned providers are now enrolled with CHC or not? Their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Shametria Tann NPI# 1124615612  Provider Name: Stephane Cyriaque NPI# 1780192633  Please let me know if you have any questions. Thank you!\" ', NULL, NULL, '2021-06-23 10:16:35', '2021-06-23 10:16:35'),
(36399, 1006, 28422, NULL, '2021-07-15 00:00:00.000', 'In Process', 'We received the following reply from Olier, Kris Kris.Olier@communityhealthchoice.org:  Sub: Enrollment Query - BHUCC - CHC  \"Hi Brad,  Can you complete the attached spreadsheet so that both providers can be added as rendering? If either providers are mid-level we need the supervising physician that must me par with Community. Best Health has been loaded for Community.  Kris\"  Replied with requested documents, attached for reference:   \"Hello Kris,   Please find the attached information, do let me know if anything else is required.   Thank you. \"', NULL, NULL, '2021-07-08 17:18:55', '2021-07-08 17:18:55'),
(36400, 11056, 28422, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : Kris.Olier@communityhealthchoice.org  Sub : Enrollment Query - BHUCC - CHC  Greetings  Kris,  Hope you are doing well.I wanted to get an update regarding the enrollment status and about the spreadsheet roster we sent to you in the past for the mentioned group and provider:  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 12:30:25', '2021-07-19 12:30:25'),
(36401, 11056, 28422, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to : 	Kris.Olier@communityhealthchoice.org, ProviderRelationsInquiries@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Greetings  Kris,  Hope you are doing well.I wanted to get an update regarding the enrollment status and about the spreadsheet roster we sent to you in the past for the mentioned group and provider:  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-30 12:59:59', '2021-07-30 12:59:59'),
(36402, 11056, 28422, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	Kris.Olier@communityhealthchoice.org, ProviderRelationsInquiries@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Greetings  Kris,  Hope you are doing well.I wanted to get an update regarding the enrollment status and about the spreadsheet roster we sent to you in the past for the mentioned group and provider:  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!   Call not received by Olier. Voice message has been sent.', NULL, NULL, '2021-08-03 15:24:22', '2021-08-03 15:24:22'),
(36403, 11056, 28422, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : 	Kris.Olier@communityhealthchoice.org, ProviderRelationsInquiries@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Greetings  Kris,  Hope you are doing well.I wanted to get an update regarding the enrollment status and about the spreadsheet roster we sent to you in the past for the mentioned group and provider:  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!   Call not received by Olier. Voice message has been sent again', NULL, NULL, '2021-08-10 10:23:04', '2021-08-10 10:23:04'),
(36404, 11056, 28422, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Hi Ahmed,     We will be having a meeting tomorrow on how rendering providers for urgent cares will be loaded. I will let you know by COB 8/12/21 on how we are proceeding.   Kris', NULL, NULL, '2021-08-16 15:37:05', '2021-08-16 15:37:05'),
(36405, 11056, 28422, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Hey Kris!  Hope you are doing well. Sounds good. Thank you for the updates. I will be waiting for further updates.   If you need any documents or information from me please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-08-23 14:50:42', '2021-08-23 14:50:42'),
(36406, 11056, 28422, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email sent to : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Hey Kris!  Hope you are doing well. Sir you were going to tell me about how rendering providers for urgent cares will be loaded by 8/12/21 . But you haven\'t informed me yet of the proceedings. Please provide me with the latest updates soon.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-31 11:09:32', '2021-08-31 11:09:32'),
(36407, 11056, 28422, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : CHC.Contracting@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Good Morning Kris,   Please assist with the below at your earliest opportunity.  Thank you   ', NULL, NULL, '2021-09-08 16:54:50', '2021-09-08 16:54:50'),
(36408, 11056, 28422, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  Hi Ahmed,     The request has been sent for load please allow 10 days for loading, Ms. Tann will be effective 7/9/21 once complete.     Kristina', NULL, NULL, '2021-09-24 16:51:31', '2021-09-24 16:51:31'),
(36409, 11056, 28422, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email sent to : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC   Good Afternoon!  Hope this email finds you well. Thank you so much for your assistance. Whenever the provider loading will be completed, please provide me with the welcome letter soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-10-05 15:44:14', '2021-10-05 15:44:14'),
(36410, 11056, 28422, NULL, '2021-10-21 00:00:00.000', 'Approved', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  1st email: Hi Ahmed,  We don’t send out welcome letters for rendering providers for the urgent care. The provider has been added in the claims system as a rendering provider for the urgent care.  2nd email: Ms. Tann has been added as a rendering provider for the Urgent Care.  Confirmation one:  We don’t list rendering providers in the directory. The urgent care is the primary, the rendering providers are listed in our claims system.  Effective date is : 7/9/21', NULL, NULL, '2021-10-14 13:24:24', '2021-10-14 13:24:24'),
(36411, 11056, 28422, NULL, '2021-10-21 00:00:00.000', 'Approved', 'Email received from : Kris.Olier@communityhealthchoice.org  Sub : Fwd: Enrollment Query - BHUCC - CHC  1st email: Hi Ahmed,  We don’t send out welcome letters for rendering providers for the urgent care. The provider has been added in the claims system as a rendering provider for the urgent care.  2nd email: Ms. Tann has been added as a rendering provider for the Urgent Care.  Confirmation one:  We don’t list rendering providers in the directory. The urgent care is the primary, the rendering providers are listed in our claims system.  Effective date is : 7/9/21', NULL, NULL, '2021-10-14 13:24:25', '2021-10-14 13:24:25'),
(36412, 1006, 28423, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36413, 1006, 28423, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'This enrollment is pending Aetna enrollment. ', NULL, NULL, '2021-05-25 11:00:31', '2021-05-25 11:00:31'),
(36414, 11056, 28423, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com,  Sub : Enrollment Request - BHUCC - First Health  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location in First Health. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-12 13:46:11', '2021-07-12 13:46:11'),
(36415, 11056, 28423, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to :     pdsdallas@aetna.com,    BharathB@aetna.com  Sub : Enrollment Request - BHUCC - First Health   Greetings,  Hope you are doing well. I wanted to enroll the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location in First Health. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-16 12:21:28', '2021-07-16 12:21:28'),
(36416, 11056, 28423, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to :     pdsdallas@aetna.com,    BharathB@aetna.com  Sub : Enrollment Request - BHUCC - First Health   Good Morning!  Hope you are doing well. I wanted to enroll the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location in First Health. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any details please let me know. Waiting for your response. Kindly respond to us soon.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-23 10:26:31', '2021-07-23 10:26:31'),
(36417, 11056, 28423, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com, PDS Dallas pdsdallas@aetna.com   &  MadirajuP@aetna.com  Sub : Enrollment Request - BHUCC - First Health  Good Morning!  Hope you are doing well. I wanted to enroll the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location in First Health. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  If you need any details please let me know. Waiting for your response. Kindly respond to us soon.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-30 13:43:56', '2021-07-30 13:43:56'),
(36418, 11056, 28423, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to :   MadirajuP@aetna.com   ,    BharathB@aetna.com  &       PDS Dallas pdsdallas@aetna.com  Sub : Enrollment Status Query - BHUCC - First Health  Greetings,  Hope you are doing well. I wanted to know the enrollment status of the below mentioned providers in our group Best Health Urgent Care & Clinic in First Health. Kindly inform me about the enrollment status as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-04 09:13:12', '2021-08-04 09:13:12'),
(36419, 11056, 28423, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Your request to join the network has been received.  Ref code is : NASB  Please see the attachment.', NULL, NULL, '2021-08-10 11:21:24', '2021-08-10 11:21:24'),
(36420, 11056, 28423, NULL, '2021-08-23 00:00:00.000', 'In Process', 'I had words with the Representative. He informed me that the application hasn\'t been received by credentialing department yet. It will take 30 - 90 days in credentialing.', NULL, NULL, '2021-08-16 13:31:52', '2021-08-16 13:31:52');
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
(36421, 11056, 28423, NULL, '2021-08-30 00:00:00.000', 'On Hold', 'Email received from : BharathB@aetna.com  Sub : Enrollment Status Query - BHUCC - First Health  Hi Ahmed,     The TIN does not have active contract under FH network hence provider has not loaded in system. Please reach out to Aetna Provider Services mentioned below who can in turn submit a NAF to the Aetna Local Market contact  Aetna Provider Services 800-624-0756 / 888-632-3862      Regards,  Bharath   Talked to a representative Paula. She informed me that it will be on hold until the group contract of the Practice with Aetna.', NULL, NULL, '2021-08-23 14:02:41', '2021-08-23 14:02:41'),
(36422, 11056, 28423, NULL, '2021-09-11 00:00:00.000', 'In Process', 'Email sent to : BharathB@aetna.com  Sub : Re: [EXTERNAL] Enrollment Status Query - CBUC - First Health Case 13005059  Good afternoon!  Hope you are doing well. It has been so long since you haven\'t responded to our emails. I am still waiting for the enrollment status for my applications of the below mentioned providers and practice. Please provide me with the latest updates soon.  Practice Details: Practice Name: Coastal Bend Urgent Care, LLC Practice Tax ID# 81-1890349 Practice NPI# 1427509264 Practice Address: 301 S HILLSIDE DR STE 4 BEEVILLE , TX 78102-5324 Secondary Address: 504A Houston Street George West , TX 78022-3663  Provider Details: Provider Name: Paterson, Katherine Provider NPI# : 1164776548  Provider Name: Monica Gonzalez Provider NPI# : 1871132811  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 weekend! ', NULL, NULL, '2021-09-03 14:14:32', '2021-09-03 14:14:32'),
(36423, 11056, 28423, NULL, '2021-10-01 00:00:00.000', 'On Hold', 'Email received from : BharathB@aetna.com  Sub : Enrollment Status Query - BHUCC - First Health  Hi Ahmed,     The TIN does not have active contract under FH network hence provider has not loaded in system. Please reach out to Aetna Provider Services mentioned below who can in turn submit a NAF to the Aetna Local Market contact  Aetna Provider Services 800-624-0756 / 888-632-3862      Regards,  Bharath   Talked to a representative Paula. She informed me that it will be on hold until the group contract of the Practice with Aetna.', NULL, NULL, '2021-09-24 13:55:35', '2021-09-24 13:55:35'),
(36424, 1006, 28424, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36425, 1006, 28424, NULL, '2021-06-01 00:00:00.000', 'On Hold', 'Enrollment request submitted via HealthSmart website form, attached for reference: \"Thank You For Your Submission Your form has been submitted! For new provider applications, please allow 15 business days for a HealthSmart team member to contact you.\"', NULL, NULL, '2021-05-25 11:32:26', '2021-05-25 11:32:26'),
(36426, 1006, 28424, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following email to Provider Relations - South pr.south@healthsmart.com with requested form attached:  Sub; Fw: HealthSmart.com - Join Our Network - Individual Provider - Tann  \"Hello,   Please find the requested information. Do let me know if anything else is required to proceed with this request. Thank you. \"', NULL, NULL, '2021-06-09 15:30:12', '2021-06-09 15:30:12'),
(36427, 11056, 28424, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub :  ENROLLMENT APPLICATION - HEALTH SMART - BHUCC  Greetings,  Hope you are doing well. Please find the requested information. Do let me know if anything else is required to proceed with this request.Please see the attachment.  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962  TIN# 84-4737737     Provider Name: Tann, Shametria NPI# 1124615612   Waiting to you hear from you soon.  Thank you!', NULL, NULL, '2021-06-28 14:29:07', '2021-06-28 14:29:07'),
(36428, 11056, 28424, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : ENROLLMENT APPLICATION - HEALTH SMART - BHUCC  Hi,  Thank you for your submission. The application has been forwarded to credentialing. Please follow up in 30 days for a status.  * Tann, Shametria NP.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com (Inventory Log ID : 80625)  Thanks HealthSmart Provider Relations', NULL, NULL, '2021-06-29 09:35:23', '2021-06-29 09:35:23'),
(36429, 11056, 28424, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : mdiprsupport@healthsmart.com &  pr.south@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Good evening!  Hope you are doing well. This is just a follow-up email to inquire about our credentialing request of the provider under the  below mentioned group :    Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.    Thank you! Have a great day!', NULL, NULL, '2021-07-12 16:55:29', '2021-07-12 16:55:29'),
(36430, 1006, 28424, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Received the following update from mdiprsupport@healthsmart.com:  Sub: Fw: Fw: HealthSmart.com - Join Our Network - Individual Provider - Tann  \"Hi,  Provider \" Tann, Shametria NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80625)  Thanks Healthsmart Provider Relations.\"', NULL, NULL, '2021-07-16 15:51:11', '2021-07-16 15:51:11'),
(36431, 11056, 28424, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email sent to : mdiprsupport@healthsmart.com, pr.south@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Good Afternoon!  Hope you are doing well. This is just a follow-up email to inquire about our credentialing request of the provider under the  below mentioned group :  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-07-30 13:20:24', '2021-07-30 13:20:24'),
(36432, 11056, 28424, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Hi,   Provider \" Tann, Shametria NP \" is currently in the credentialing process.  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80625)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-08-03 15:37:29', '2021-08-03 15:37:29'),
(36433, 11056, 28424, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Good Afternoon!  Hope you are doing well. This is just a follow-up email to inquire about our credentialing request of the provider under the below mentioned group :  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-10 11:25:26', '2021-08-10 11:25:26'),
(36434, 11056, 28424, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Email sent to : pr.south@healthsmart.com &  mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Good morning!  Hope all is well. Could you please provide us the time frame for the completion of our credentialing request?  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great week ahead!', NULL, NULL, '2021-08-16 16:12:19', '2021-08-16 16:12:19'),
(36435, 11056, 28424, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Hi,  \" Tann, Shametria NP \" is effective date \" 09/01/2021 \".  All communication, including requested documents should be sent to pr.south@healthsmart.com. Please do not submit to MDIPR@healthsmart.com  (Inventory Log ID : 80625)  Thanks Healthsmart Provider Relations.', NULL, NULL, '2021-08-23 14:58:14', '2021-08-23 14:58:14'),
(36436, 11056, 28424, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Hi,  Provider \'\' Tann, Shametria NP \'\' is Effective \'\' 09/01/2021 \'\'  * The location below has been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :80625)  Thanks. HealthSmart Provider Relations.', NULL, NULL, '2021-08-31 13:49:32', '2021-08-31 13:49:32'),
(36437, 11056, 28424, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to : mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Good morning!  Hope all is well. Is Tann, Shametria NP approved in Health smart ? And if she is approved please provide us the approval or welcome letter to us soon.  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-09-08 16:36:31', '2021-09-08 16:36:31'),
(36438, 11056, 28424, NULL, '2021-10-01 00:00:00.000', 'In Process', 'Email received from : pr.south@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Welcome letters go out after the committee approvals at the beginning of next month.     Diamond Lucero |Sr. Provider Relations HealthSmart | Network Solutions Office: 214 574 1174 I Fax: 214 574 2368 6303 Commerce Drive | Suite 180 | Irving, TX 75039 pr.south@healthsmart.com | www.HealthSmart.com ', NULL, NULL, '2021-09-24 15:31:03', '2021-09-24 15:31:03'),
(36439, 11056, 28424, NULL, '2021-10-12 00:00:00.000', 'Approved', 'Approval Email received from : mdiprsupport@healthsmart.com  Sub : ENROLLMENT STATUS QUERY - HEALTH SMART - BHUCC  Hi,  Provider \'\' Tann, Shametria NP \'\' is Effective \'\' 09/01/2021 \'\'  * The location below has been added.  All communication, including requested documents should be sent to pr.south@healthSmart.com. Please do not submit to MDIPR@healthsmart.com.   (Inventory Log ID :80625)  Thanks. HealthSmart Provider Relations.  Please see the attachment.', NULL, NULL, '2021-10-05 09:16:58', '2021-10-05 09:16:58'),
(36440, 1006, 28425, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36441, 1006, 28425, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Submitted enrollment online via Multiplans nomination portal:  \"Thank you for your interest in participating with MultiPlan. You should receive an application within ten to fifteen business days. If you do not receive the application, or if you have any questions upon reviewing it, please contact our Service Operations department at (800) 950-7040. You can check the status of your request anytime through the Check Nomination Status option on this page.  Nomination Tracking Number: 0512219EH\"', NULL, NULL, '2021-05-12 10:51:10', '2021-05-12 10:51:10'),
(36442, 3040, 28425, NULL, '2021-06-16 00:00:00.000', 'In Process', 'I had a word with (Paul) Multiplan representative and he send the provider information form need to fill and send it back.   Case # 7635140', NULL, NULL, '2021-06-09 16:06:14', '2021-06-09 16:06:14'),
(36443, 1006, 28425, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Sent following PIF @ PIF@multiplan.com:  Sub: Provider Interest Form - BHUCC - Shametria Tann  \"Hello,  As requested please find the attached PIF for our provider, please let me know if anything else is required to proceed with this request and how long the process will take? Thank you.\"', NULL, NULL, '2021-06-09 16:12:50', '2021-06-09 16:12:50'),
(36444, 11056, 28425, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Email sent to  : registrar@multiplan.com  Sub : ENROLLMENT APPLICATION - MULTIPLAN - BHUCC  Greetings,  Hope you are doing well. As requested please find the attached PIF for our provider, please let me know if anything else is required to proceed with this request and how long the process will take?  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962  TIN# 84-4737737     Provider Name: Tann, Shametria NPI# 1124615612   Waiting to hear from you soon.  Thank you!', NULL, NULL, '2021-06-28 14:51:50', '2021-06-28 14:51:50'),
(36445, 11056, 28425, NULL, '2021-07-06 00:00:00.000', 'In Process', 'Provider Portal Form submitted CASE NO. : 7654369', NULL, NULL, '2021-06-28 14:54:15', '2021-06-28 14:54:15'),
(36446, 11056, 28425, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Request - BHUCC - Multiplan  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group Best Health Urgent Care & Clinic as there are 2 providers now in the group. Kindly inform me about the enrollment procedure as soon as possible.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612 Enrollment Status : Need an update from you about this too.  Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633 Enrollment Status : APPROVED ( already )  If you need any details please let me know. Waiting for your response.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-12 14:58:59', '2021-07-12 14:58:59'),
(36447, 11056, 28425, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com  Sub : Enrollment Request - BHUCC - Multiplan  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group Best Health Urgent Care & Clinic as there are 2 providers now in the group. Kindly inform me about the enrollment procedure as soon as possible? Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612 Enrollment Status : Need an update from you about this too.  Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633 Enrollment Status : APPROVED ( already ) If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-19 14:56:15', '2021-07-19 14:56:15'),
(36448, 11056, 28425, NULL, '2021-08-05 00:00:00.000', 'In Process', 'Email sent to : registrar@multiplan.com>  Sub : ENROLLMENT APPLICATION - MULTIPLAN - BHUCC  Good morning,  Reference # Task ID: 2301831 .Sorry about that, here it is.   Furthermore, If you need any documents & information please let me know.  Thank you!', NULL, NULL, '2021-07-28 16:33:17', '2021-07-28 16:33:17'),
(36449, 11056, 28425, NULL, '2021-08-11 00:00:00.000', 'In Process', 'I had words with Shanda of Multiplan. She informed me that the application or request is in last stages. They will be going to send us welcome packet soon. Ref no. # : 7693390', NULL, NULL, '2021-08-03 17:04:32', '2021-08-03 17:04:32'),
(36450, 11056, 28425, NULL, '2021-08-11 00:00:00.000', 'Approved', 'Approval email received from : welcomepackets@multiplan.com  Sub : SECURE: MultiPlan Network Participation (13924267-10189814)  Dear Provider/Administrator,  Please review the attached documents regarding the participation of Tann, Shametria, MSN, in the MultiPlan Networks.  If you have any questions regarding the content of this email, you may request service online at: https://custservice.multiplan.com.  Attachments include: o Participation Letter o Working with Multiplan Information  NOTICE OF CONFIDENTIALITY: Information included in and/or attached to this transmission may be confidential. This transmission is intended for the addressee(s) only. Any unauthorized disclosure, reproduction, or distribution of and /or any unauthorized action taken in reliance on the information in this transmission is prohibited. If you believe that you received this transmission in error, please notify the sender by reply transmission and destroy the transmission without copying or disclosing it. We may also need to contact you for additional information as required by HIPAA or state law.  This message was secured by Zix(R).   Welcome Letter is attached. Please see the attachment.', NULL, NULL, '2021-08-04 10:18:57', '2021-08-04 10:18:57'),
(36451, 1006, 28426, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36452, 1006, 28426, NULL, '2021-06-14 00:00:00.000', 'Approved', 'The group is enrolled under ancillary contract, no need to enroll provider individually. The group task has further information. ', NULL, NULL, '2021-06-07 14:38:38', '2021-06-07 14:38:38'),
(36453, 1006, 28427, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36454, 1006, 28427, NULL, '2021-05-19 00:00:00.000', 'Initiated', 'Enrollment Application Status   Application Status PEP Ticket Number Submitted		17779045 ', NULL, NULL, '2021-05-12 08:01:04', '2021-05-12 08:01:04'),
(36455, 1006, 28427, NULL, '2021-06-10 00:00:00.000', 'Approved', 'The provider has been enrolled with Medicaid, approval and location confirmation is attached. ', NULL, NULL, '2021-06-03 17:17:24', '2021-06-03 17:17:24'),
(36456, 1006, 28428, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:58', '2021-05-06 07:45:58'),
(36457, 1006, 28428, NULL, '2021-06-01 00:00:00.000', 'Initiated', 'Memorial Hermann enrollment is covered under Aetna plans, pending Aetna enrollment. ', NULL, NULL, '2021-05-25 11:41:31', '2021-05-25 11:41:31'),
(36458, 1006, 28428, NULL, '2021-06-01 00:00:00.000', 'On Hold', '', NULL, NULL, '2021-05-25 11:41:38', '2021-05-25 11:41:38'),
(36459, 1006, 28428, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request has been put on hold as per my discussion with Stephane, he is unable to provide Memorial Hermann with what they are requesting at the moment. We will have to submit a new request at a later time. ', NULL, NULL, '2021-06-07 11:02:28', '2021-06-07 11:02:28'),
(36460, 1006, 28430, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36461, 1006, 28430, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request query @ MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Query - BHUCC - Molina  \"Hello,  I hope you\'re doing well, we wish to enroll the following provider with Molina as a PCP under our group, please let me know how we can do so. The information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962  Provider Name: Shametria Tann NPI# 1124615612  Please get back to me as soon as you\'re able.  Thank you. \"', NULL, NULL, '2021-06-07 16:10:11', '2021-06-07 16:10:11'),
(36462, 1006, 28430, NULL, '2021-07-01 00:00:00.000', 'In Process', 'We received the following response from MHMSProviderContracting MHMSProviderContracting@molinahealthcare.com:  Sub: Enrollment Query - BHUCC - Molina  \"Good Afternoon Brad,  I believe it’s possible that you’ve reached the MS Health Plan by mistake. I don’t believe this group is contracted with us in the state of Mississippi. Please see the following contact information for the TX Molina Health Plan.  Texas CREDENTIALING MHT.Credentialing@MolinaHealthCare.Com  PROVIDER NETWORK ADMIN MHTProviderNetworkAdmin@MolinaHealthCare.Com  CONTRACTING MHTContracting2@MolinaHealthCare.Com  CONTRACT REQUEST MHTContractrequest@MolinaHealthCare.Com   PROVIDER SERVICES MHTXProviderServices@MolinaHealthCare.Com  Provider Contracts Description: Description: Description: Description: Description: cid:image002.jpg@01CDB5C6.D25A2E90 Molina Healthcare of Mississippi, Inc. 188 East Capitol Street, Suite 700 Jackson, MS  39201\"  Sent corrected email @ MHT.Credentialing@MolinaHealthCare.Com & MHTXProviderServices@MolinaHealthCare.Com. ', NULL, NULL, '2021-06-24 13:49:52', '2021-06-24 13:49:52'),
(36463, 11056, 28430, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Request - BHUCC - Molina  Good afternoon,  Hope all is well. Here is the enrollment form for Provider and roster of Practice to add provider to an existing contract. Kindly see the attachments.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Provider : Provider Name: Tann, Shametria Provider  NPI # : 1124615612  If you need any information or documents please let me know . Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-13 15:45:38', '2021-07-13 15:45:38'),
(36464, 11056, 28430, NULL, '2021-07-29 00:00:00.000', 'In Process', 'Email sent to : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Request - BHUCC - Molina  Good afternoon,  Hope all is well. Here is the enrollment form for Provider and roster of Practice to add provider to an existing contract. Kindly see the attachments.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Provider : Provider Name: Tann, Shametria Provider  NPI # : 1124615612  If you need any information or documents please let me know . Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-22 13:24:23', '2021-07-22 13:24:23'),
(36465, 11056, 28430, NULL, '2021-08-02 00:00:00.000', 'Approved', 'Approval email received from : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Request - BHUCC - Molina  Good morning,  Happy Tuesday!!  Thank you for your interest in joining Molina healthcare network.  I have received your contract request form, however, I noticed pay to NPI number belongs to urgent care.  Molina does not contract individual providers to urgent care.  Molina contract urgent care itself.  I also show facility is already contracted with Molina healthcare effective date 10/1/2020.  Thank you  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249    Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. As the facility is now contracted as and Urgent Care with molina so all the practicing providers will be considered in-network.', NULL, NULL, '2021-07-26 08:52:51', '2021-07-26 08:52:51'),
(36466, 1006, 28431, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36467, 1006, 28431, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Thank You For Your Request! Important to Note:  Prior to a new provider’s provision of services and receipt of claims reimbursement, program enrollment must be confirmed on requests for Superior Medicaid (STAR, STAR Health, STAR Kids and STAR+PLUS), CHIP and/or Long-Term Services and Supports (LTSS) programs.  Superior will notify you of acceptance or non-acceptance to our network no later than 90 days from receipt of a complete application for participation.  If additional information is required to process your request, a Superior representative will contact you soon. ', NULL, NULL, '2021-05-28 16:37:15', '2021-05-28 16:37:15'),
(36468, 3040, 28431, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria & Cyriaque, Stephane || Superior Health ||  Greetings,   Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  Provider Name: Cyriaque, Stephane Provider NPI# 1780192633  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 15:50:55', '2021-06-09 15:50:55'),
(36469, 11056, 28431, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to :  AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned providers in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.   Thank you!', NULL, NULL, '2021-06-28 12:49:51', '2021-06-28 12:49:51'),
(36470, 11056, 28431, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good afternoon Ahmed,  Hope you had a restful weekend  Here is the information you requested for the following Providers under Best Health Urgent Care and Clinic  NPI#1013540962  TID#844737737  Provider Details: Provider Name : Tann, Shametria--- Per review awaiting Provider response, packet sent on 6/2/2021 Provider NPI# : 1124615612  Veronica Botello Rocha  Provider Relations Coordinator II  Provider Relations Department  Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-07-12 16:06:48', '2021-07-12 16:06:48'),
(36471, 11056, 28431, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email received from : AM.CorpusChristi@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  The email packet would come from the Network Development and Credentialing Team  I have included the email so that way you can address the questions on what they are needing  From the Provider :  Credentialing@superiorhealthplan.com    Veronica Botello Rocha Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-07-13 13:35:39', '2021-07-13 13:35:39'),
(36472, 11056, 28431, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  We have not received the credentialing application for the provider listed below.  Please resubmit.  Thank you,  Leslie Gilchrist Intake Coordinator Contract Management', NULL, NULL, '2021-07-22 14:39:37', '2021-07-22 14:39:37'),
(36473, 11056, 28431, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to :  SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Afternoon!  Hope all is well. Here is the credentialing application for the provider listed below for the Best Health Urgent Care & Clinic for plan Superior Healthplan :   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Providers Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  If you further need any documents or information feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-26 09:41:36', '2021-07-26 09:41:36'),
(36474, 11056, 28431, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to :  SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good Afternoon!  Hope all is well. Here is the credentialing application for the provider listed below for the Best Health Urgent Care & Clinic for plan Superior Healthplan :   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Providers Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  If you further need any documents or information feel free to reach out to me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-26 09:41:39', '2021-07-26 09:41:39'),
(36475, 11056, 28431, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  &   SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-03 17:10:07', '2021-08-03 17:10:07'),
(36476, 11056, 28431, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : AM.Houston@superiorhealthplan.com  &   SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Greetings,  Hope you are doing well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  Please get back to me as soon as you can get a chance. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!   Called them but all the employees are working from home. No one attended the call . Voice message has been left out.', NULL, NULL, '2021-08-10 14:35:17', '2021-08-10 14:35:17'),
(36477, 11056, 28431, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  &   SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good afternoon,   After reviewing the application status for the provider below, I see the application is under Provider Validation status. At This time, our Network Development Team is validating provider information. Provider packet was received on 7/22/2021, and is currently being worked on.   Credentialing process can take between 60 -120 days. Please allow more time for application to process.  Thank you, Yesenia Prado  Provider Relations Coordinator II Provider Relations Department Nueces, Harris & Jefferson SDAs', NULL, NULL, '2021-08-16 13:57:49', '2021-08-16 13:57:49'),
(36478, 11056, 28431, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||   Good morning!  Hope this email finds you well. I wanted to know the enrollment status for the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location. Please provide me with the latest updates soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name : Tann, Shametria Provider NPI# : 1124615612  If you need any documents or information please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-23 15:08:28', '2021-08-23 15:08:28'),
(36479, 11056, 28431, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Hello  We received your completed application on 7/22/2021.  It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.  Blessings,     Jillyan Galindo  Project Coordinator I, Contract Management', NULL, NULL, '2021-08-31 13:45:16', '2021-08-31 13:45:16'),
(36480, 11056, 28431, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email sent to ; SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good afternoon Jillyan!  Hope all is well. Thank you so much for the updates. Please provide the welcome packet and letter soon, whenever the provider\'s enrollment process is completed.  If you need any information or documents from me please let me know. Waiting for your response.  Thank you! Have a great day!', NULL, NULL, '2021-09-08 16:48:34', '2021-09-08 16:48:34'),
(36481, 11056, 28431, NULL, '2021-09-27 00:00:00.000', 'In Process', 'Rep name : Yesenia P  Status : Application is under credentialing Dept. take time 30 to 60 days . Application is in process  Interaction code : 59302  Contact no. : 800-656-4817', NULL, NULL, '2021-09-20 09:06:03', '2021-09-20 09:06:03'),
(36482, 11056, 28431, NULL, '2021-10-05 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good morning!  Hope all is well with you. I want to get a latest update regarding my application of below mentioned provider under the practice Tax I.D with Superior Health plan promptly.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# : 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Providers Details: Provider Name : Shametria Tann Provider NPI# : 1124615612  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, '2021-09-28 14:30:16', '2021-09-28 14:30:16'),
(36483, 11056, 28431, NULL, '2021-10-12 00:00:00.000', 'In Process', 'Email received from : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Hello  We received your completed application on 8/6/21. It is currently in credentialing.  Please note that we will notify you of acceptance / participation status within 90 days of receipt of completed application.  Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you, Leslie Gilchrist Intake Coordinator Contract Management', NULL, NULL, '2021-10-05 09:42:58', '2021-10-05 09:42:58'),
(36484, 11056, 28431, NULL, '2021-10-21 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||   Good morning,  After reviewing the application status for the provider below, I see the application is under Credentialing status. Application Packet was received on  7/22/2021.   Credentialing process can take between 60 -120 days. Please allow more time for application to process.', NULL, NULL, '2021-10-14 13:16:47', '2021-10-14 13:16:47'),
(36485, 11056, 28431, NULL, '2021-10-28 00:00:00.000', 'In Process', 'Email sent to : SHP-NETWORKDEVELOPMENT@superiorhealthplan.com & AM.Houston@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good morning!  Hope all is well with you. I want to get the latest updates on my credentialing application of below mentioned provider under the facility Tax I.D.  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242 Provider Name	NPI Shametria Tann  (FNP) 	1124615612   If you require any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-10-21 15:49:51', '2021-10-21 15:49:51'),
(36486, 11056, 28431, NULL, '2021-11-08 00:00:00.000', 'In Process', 'Email received from : AM.Houston@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good morning,     After reviewing the application status for the provider below, I see the application is under Credentialing status. Application Packet was received on  7/22/2021.      Credentialing process can take between 60 -120 days. Please allow more time for application to process.   Please see the attachment.', NULL, NULL, '2021-11-01 10:52:12', '2021-11-01 10:52:12'),
(36487, 11056, 28431, NULL, '2021-11-19 00:00:00.000', 'In Process', 'Email sent to:  SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub : [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health ||  Good morning!  Hope you are doing well. As you informed me, you received the application packet on 7/22/2021, and from that date, the application has completed almost 80 days in processing with Superior health plan. Therefore, can we expect to receive a welcome packet from you soon?   Eagerly, waiting to hear from you soon.  Thank you! Have a wonderful day!', NULL, NULL, '2021-11-12 16:49:04', '2021-11-12 16:49:04'),
(36488, 11056, 28431, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from:  Daniel.McAneny@superiorhealthplan.com   Sub :   Credentialing Request; Shametria Tann 1124615612  Good Morning,  We received your credentialing application for Shametria Tann; however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below:                      Completed Conflict of Interest Disclosure form (“I do” or “I do not” must be checked and all forms must be signed and dated by provider even if not applicable)                         Completed Disclosure of Prior Contracts form (“Yes” or “No” must be checked and all forms must be signed and dated by provider even if not applicable)     You may fax or email the requested information to the contact information listed below.     Fax: 866-702-4831                Phone: 1-800-820-5686  Warm Regards,  Daniel McAneny Credentialing  Specialist I Pronouns: He/Him/His     Superior HealthPlan 5900 E. Ben White Blvd Austin, TX 78741  Direct 1-800-218-7453 Ext 42175 Fax: 1-866-702-4831 Daniel.mcaneny@SuperiorHealthPlan.com | SuperiorHealthPlan.com', NULL, NULL, '2021-11-29 13:43:51', '2021-11-29 13:43:51'),
(36489, 11056, 28431, NULL, '2021-12-15 00:00:00.000', 'In Process', 'Email received from: daniel.mcaneny@superiorhealthplan.com  Sub:   Good evening!  Hope all is well with you. Please provide the recent accomplishments of the process. Any updates on the credentialing process?  Awaiting the welcome letter and packet for the provider. Also, let me know about that too!  Thank you! Have a great day!', NULL, NULL, '2021-12-08 16:53:58', '2021-12-08 16:53:58'),
(36490, 11056, 28431, NULL, '2021-12-24 00:00:00.000', 'In Process', 'Email sent to: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Sub: [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health || Credentialing Request; Shametria Tann 1124615612   Good morning!  Hope all is well with you. I want to get the latest updates on my credentialing application of below mentioned provider under the facility Tax I.D. Awaiting for the welcome letter and packet for the provider. Also let me know about that too!  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 TEXAS PKWY UNIT B, MISSOURI CITY, TX 77489-5242 Provider Name	NPI Shametria Tann  (FNP) 	1124615612   If you require any documents or information feel free to contact me. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-12-17 10:46:08', '2021-12-17 10:46:08'),
(36491, 11056, 28431, NULL, '2021-12-30 00:00:00.000', 'In Process', 'Email received from: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com  Subject:  [SECURE] STATUS REQUEST_ Enrollment Status || Best Health Urgent Care & Clinic || Superior Health || We received your completed application on 8/6/21. Your projected effective date is 1/1/2022. Currently In the process of being loaded in our system. Upon completion of this provider’s enrollment, your agreement will be executed and welcome packet will be sent.     Thank you,  Leslie Gilchrist Intake Coordinator Contract Management', NULL, NULL, '2021-12-23 10:45:25', '2021-12-23 10:45:25'),
(36492, 19067, 28431, NULL, '2022-01-11 00:00:00.000', 'In Process', 'Email sent to: SHP-NETWORKDEVELOPMENT@superiorhealthplan.com, Daniel.McAneny@superiorhealthplan.com  Subject: Enrollment Query || BHUCC || Shametria Tann || Superior Health ||  Good Morning!  Hope you are doing well.  I would like to know the enrollment status of the following Provider.  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary Location	3003 Texas Pkwy Unit B, Missouri City, TX 77489-5242 Provider Name	NPI Shametria Tann	1124615612  Kindly respond promptly!  Thanks & Regards, Ahmed, Hammad.', NULL, NULL, '2022-01-04 09:57:56', '2022-01-04 09:57:56'),
(36493, 19067, 28431, NULL, '2022-01-17 00:00:00.000', 'In Process', 'Email sent to: 	SHP-NETWORKDEVELOPMENT@superiorhealthplan.com, Daniel.McAneny@superiorhealthplan.com, AM.CorpusChristi@superiorhealthplan.com  Subject: Enrollment Query || BHUCC || Shametria Tann || Superior Health ||     Hello!  Hope this email finds you well.  This is my second reminder on the previously mentioned request.  Kindly get back in touch as soon as you have time.  Thanks! Hammad Ahmed.', NULL, NULL, '2022-01-09 19:18:48', '2022-01-09 19:18:48'),
(36494, 19067, 28431, NULL, '2022-01-21 00:00:00.000', 'Approved', 'Email received from: AM.CorpusChristi@superiorhealthplan.com  Subject: Case 74732 RE: Enrollment Query || BHUCC || Shametria Tann || Superior Health ||     Good morning, hope all is well. The provider\'s effective date is 1/1/2022.     Thank you,     Deidra Hernandez  Provider Account Manager  Toll-Free: 1-800-656-4817 Option 1, then Option 3 Fax: 1-866-683-5630 AM.Houston@SuperiorHealthPlan.com | SuperiorHealthPlan.com', NULL, NULL, '2022-01-14 10:55:50', '2022-01-14 10:55:50'),
(36495, 1006, 28432, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36496, 1006, 28432, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Certification form has been filled and faxed out to (608) 221-7535. Attached for reference.  ', NULL, NULL, '2021-06-07 14:32:39', '2021-06-07 14:32:39'),
(36497, 1006, 28432, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent f/u email @ Yvonne Wyatt ywyatt@humana.com:  Sub; Certification Status - BHUCC - Tricare  \"Hello Yvonne,  I wanted to verify if the following provider is coming up as a certified provider with Tricare yet or not, their information is as follows:  Provider Name: Shametria Tann NPI# 1124615612  Please get back to me as soon as possible.  Thank you!\"', NULL, NULL, '2021-06-24 13:52:57', '2021-06-24 13:52:57'),
(36498, 1006, 28432, NULL, '2021-07-15 00:00:00.000', 'In Process', 'We received the following update from Yvonne Wyatt ywyatt@humana.com:  Sub: Certification Status - BHUCC - Tricare  \"Good Afternoon Brad,  Shametria Tann, do not appear in our system as TRICARE certified. Fax the completed certification application to WPS.  Highlighted below is the link to the certification applications.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535  Thanks, Yvonne W. Wyatt, Humana Military  TRICARE Community Liaison II Houston/Galveston 502-318-5409 Telephone 502-322-8018 Fax ywyatt@humana.com  https://www.humanamilitary.com/coronavirus/provider https://infocenter.humana-military.com/provider/service/Account/Login  Certification takes 90 days, and I do not visual access to check the status. To check the status of Tricare WPS Certification applications, call 800-444-5445, and press option 2,2,5 and then 1.  Certification applications forms please visit: https://www.humanamilitary.com/provider/education-and-resources/quick-access/forms Certification Fax: 608-221-7535 Provider Handbook: http://apps.humana.com/marketing/documents.asp?file=3262194\"  Replied with:  \"Hello Yvonne,   I appreciate the update but I submitted the certification request back on 06/07/2021. Please let me know what the expected time frame is for certification to be completed?  Thank you. \"', NULL, NULL, '2021-07-08 14:38:25', '2021-07-08 14:38:25'),
(36499, 11056, 28432, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email sent to : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Tricare ||  Good morning Yvonne!  Hope all is well. I wanted to inquire about the enrollment status of the provider and group. Please respond we have also faxed the documents of the provider at 608-221-7535 .Kindly update me with the enrollment status of the below mentioned provider and group.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-20 09:45:15', '2021-07-20 09:45:15'),
(36500, 11056, 28432, NULL, '2021-08-03 00:00:00.000', 'On Hold', 'Email received from : ywyatt@humana.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Cyriaque, Stephane || Tricare ||  Good Morning Brad,  You can check with us in 6 months to see if the Panel is open to new providers.       As a non-network TRICARE certified  provider you can see TRICARE Beneficiaries who has the following plans     •            Tricare Select  •            Tricare for Life  •            Tricare Reserve Select  •            Tricare Retired Reserve  •            Tricare Retired Reserved  •            Tricare Young Adult               Thanks,  Yvonne W. Wyatt,  Humana Military  TRICARE Community Liaison II  Houston/Galveston  502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com', NULL, NULL, '2021-07-27 10:45:02', '2021-07-27 10:45:02'),
(36501, 22077, 28432, NULL, '2022-04-21 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Hi,  I would like to enroll the following provider  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary & Billing Address	3003 TEXAS PKWY UNIT B MISSOURI CITY, TX 77489-5242 Provider Name	NPI Stephane Cyriaque	1780192633 Shametria Tann	1124615612  Looking forward to your kind response. Have a great day!  Thanks & Regards, Alex.', NULL, NULL, '2022-04-14 13:18:25', '2022-04-14 13:18:25');
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
(36502, 22077, 28432, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email received from: ywyatt@humana.com  Subject: RE: Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Good Afternoon Alex,     We show both Providers are affiliated to this group tax id. You can check status by using the online Self Service Provider Portal. Highlighted below is the link to create a log in.              In order to serve our providers more efficiently, we have begun using Humana Military’s Provider Self-Service Portal.  The secure messaging feature through Provider Self Service increases the timeliness of responses to your questions.  If you are not currently registered on the Provider Self-Service Portal, please visit:  Provider Self-Service (humana-military.com)  To verify provider status, please utilize the NPI search tool in the Provider Self-Service Portal.  If the provider does not populate in this tool, then the provider is not TRICARE certified.     Thanks,  Yvonne W. Wyatt,  TRICARE Community Liaison II  Humana Military     502-318-5409 Telephone  502-322-8018 Fax  ywyatt@humana.com     HumanaMilitary.com  Additional Resources:  ** Provider claims, certification and other forms  ** Rates and reimbursements', NULL, NULL, '2022-04-25 13:20:10', '2022-04-25 13:20:10'),
(36503, 22077, 28432, NULL, '2022-05-02 00:00:00.000', 'In Process', 'Email sent to: ywyatt@humana.com  Subject: 	Re: Enrollment Query || Stephane Cyriaque & Shametria Tann || BHUCC || Tricare  Hi,  I want to know the effective date for both providers,  Group Name	Best Health Urgent Care & Clinic Tax ID	84-4737737 Group NPI	1013540962 Primary & Billing Address	3003 TEXAS PKWY UNIT B MISSOURI CITY, TX 77489-5242 Provider Name	NPI Stephane Cyriaque	1780192633 Shametria Tann	1124615612  I am looking forward to your kind response.  Thanks & Regards. ', NULL, NULL, '2022-04-25 13:21:48', '2022-04-25 13:21:48'),
(36504, 1006, 28433, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36505, 1006, 28433, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Submitted group & provider enrollment request, it\'s attached for reference. ', NULL, NULL, '2021-06-07 09:44:03', '2021-06-07 09:44:03'),
(36506, 1006, 28433, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent following email to \".ProspectiveProviderTX\" ProspectiveProviderTX@wellcare.com;  Sub; RE: Become A Provider - Unsecured - Not Applicable - Texas  \"Hello,   I appreciate the update but the provider Shametria Tann needs to be set up as a PCP under our group, please let me know what is required to proceed with that request?  Thank you!\"', NULL, NULL, '2021-06-24 14:26:18', '2021-06-24 14:26:18'),
(36507, 11056, 28433, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,  We will send this over to Account Management for update.  Thanks.', NULL, NULL, '2021-07-13 13:48:39', '2021-07-13 13:48:39'),
(36508, 11056, 28433, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Enrollment Process Update - BHUCC - Wellcare  Greetings,  Hope you are doing well. Any update on Shametria Tann enrollment to be set up as a PCP under our group mentioned below ?  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Provider : Provider Name: Tann, Shametria Provider  NPI # : 1124615612  If you need any information or documents please let me know . Waiting to hear from you soon.  Thank you! Have a great day! ', NULL, NULL, '2021-07-22 14:47:09', '2021-07-22 14:47:09'),
(36509, 11056, 28433, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,  Update request was sent in we will let you know as soon as it is complete.  Thanks Network Development', NULL, NULL, '2021-07-26 09:34:32', '2021-07-26 09:34:32'),
(36510, 11056, 28433, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from : ProspectiveProviderTX@wellcare.com  Sub : Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   The request was sent 7.13.2021 to have the provider updated as PCP. It should not take much longer to be updated. I will let you know once the request is complete.   Thanks  Network Development', NULL, NULL, '2021-07-27 13:27:39', '2021-07-27 13:27:39'),
(36511, 11056, 28433, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to : ProspectiveProviderTX@wellcare.com  Sub : Become A Provider - Unsecured - Not Applicable - Texas  Greetings,  Hope you are doing well. Any update on Shametria Tann enrollment to be set up as a PCP under our group mentioned below ? How much more time needed for the completion of enrollment or credentialing process take ?  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Provider : Provider Name: Tann, Shametria Provider  NPI # : 1124615612  If you need any information or documents please let me know . Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-27 13:37:55', '2021-07-27 13:37:55'),
(36512, 11056, 28433, NULL, '2021-08-06 00:00:00.000', 'Approved', '05/01/2021  Please see attachment.', NULL, NULL, '2021-07-29 14:16:25', '2021-07-29 14:16:25'),
(36513, 11056, 28433, NULL, '2021-08-06 00:00:00.000', 'Approved', 'Approval email received from : ProspectiveProviderTX@wellcare.com  Sub : Fwd: Become A Provider - Unsecured - Not Applicable - Texas  Good Afternoon,   Please see welcome letters and contract.   Let us know if you have any questions.   Thanks  Network Management – Texas | www.wellcare.com | www.superiorhealthplan.com  Shametria eff date is : 06/18/2021  STEPHANE eff date is : 05/01/2021  Please see the attachment', NULL, NULL, '2021-07-29 14:17:27', '2021-07-29 14:17:27'),
(36514, 1006, 28434, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36515, 1006, 28434, NULL, '2021-06-01 00:00:00.000', 'Initiated', 'Submitted enrollment request via PalmetoGBA website: \"Reference Number :	21145000578\"', NULL, NULL, '2021-05-25 11:40:07', '2021-05-25 11:40:07'),
(36516, 1006, 28434, NULL, '2021-06-08 00:00:00.000', 'Approved', 'Your active Railroad Medicare PTAN has been located and is shown here :  PROVIDER NAME	SHAMETRIA TANN NP PROVIDER PTAN	Q00076615 PROVIDER NPI	1124615612 EFFECTIVE DATE	02/05/2021 END DATE	 GROUP NAME	BEST HEALTH URGENT CARE & CL GROUP PTAN	DZ8560 BUSINESS STATE	TX EFFECTIVE DATE	02/25/2020 END DATE	  Approval confirmation is attached for reference. ', NULL, NULL, '2021-06-01 09:02:23', '2021-06-01 09:02:23'),
(36517, 1006, 28435, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36518, 1006, 28435, NULL, '2021-06-04 00:00:00.000', 'Not Eligible', 'Florida only insurance, not eligible for enrollment in Texas. ', NULL, NULL, '2021-05-28 14:28:32', '2021-05-28 14:28:32'),
(36519, 1006, 28436, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36520, 1006, 28436, NULL, '2021-05-16 00:00:00.000', 'Initiated', 'Submitted Enrollment application: Enrollment Tracking Information Applicant Name: SHAMETRIA TANN  Tracking ID: T050620210001378  Reassignment Tracking ID: T050620210001430  Submitted Date: THU - MAY 06 2021 02:48:12 PM EST  Submitted By: Shametria Tann  Contact Email(s): S_TANN@YAHOO.COM BHUCC@CLAIMSMEDINC.COM Reason(s) for submission: A Medicare Part B practitioner is enrolling in the Medicare program for the first time to bill for Part B services. A reassignment of benefits may exist.', NULL, NULL, '2021-05-06 13:49:21', '2021-05-06 13:49:21'),
(36521, 1006, 28436, NULL, '2021-05-21 00:00:00.000', 'Approved', 'Application Tracking ID: T050620210001378   NPI ID: 1124615612   Medicare ID: 1P0365   Name: SHAMETRIA TANN  State: TX   Form Type: 855I  Date: 05/11/2021  Status: APPROVED', NULL, NULL, '2021-05-11 08:23:48', '2021-05-11 08:23:48'),
(36522, 1006, 28437, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36523, 1006, 28437, NULL, '2021-06-01 00:00:00.000', 'Initiated', 'Sent following enrollment request to Michelle Monroe mmonroe@ghn-mci.com:  Sub: Provider Enrollment - Shametria Tann - BHUCC  \"Hello Michelle,   I hope you\'re doing well, our group has a new provider and I wanted to know what is required to get her enrolled under it, the group and provider information are as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962  Provider Name: Tann, Shametria NPI# 1124615612  Please get back to me as soon as you\'re able to.   Thank you.\"', NULL, NULL, '2021-05-25 11:21:18', '2021-05-25 11:21:18'),
(36524, 3040, 28437, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: mmonroe@ghn-mci.com  Subject: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Galaxy Health ||  Greetings,   Hope you are doing well. I wanted to enroll the below mentioned provider in our group Best Health Urgent Care & Clinic under the below location.   Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider Name: Tann, Shametria Provider NPI# 1124615612  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 14:49:21', '2021-06-09 14:49:21'),
(36525, 1006, 28437, NULL, '2021-06-28 00:00:00.000', 'In Process', 'We received the following reply from Michelle Monroe mmonroe@ghn-mci.com:  Sub; Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Galaxy Health ||   \"Hello,  Please see the attached Agreement needed to enroll your provider. If you should have any questions, please feel free to contact me.  Thank you, Michelle   Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network  2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425 mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497 \"  Sent following reply:  \"Hello Michelle,   I wanted to verify if we had a group contract or are we still not eligible for one until we have two providers enrolled with Galaxy Health?  Thank you! \"', NULL, NULL, '2021-06-21 16:28:43', '2021-06-21 16:28:43'),
(36526, 1006, 28437, NULL, '2021-07-15 00:00:00.000', 'In Process', 'We received the following response from Michelle Monroe mmonroe@ghn-mci.com:  Sub: Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Galaxy Health ||  \"Hi Brad,  I do apologize for the delay in getting back with you. You had asked on your voicemail, if you could fill this out as a group or individually. We would prefer the entire clinic of providers.  What we will need is One Agreement, and each provider would need to fill out their own application (Provider Data Record- attached with Agreement) or you are welcome to send in their CAQH in place of, along with all credentials that apply to each provider you are adding,  If you should have any questions, please feel free to reach out to me.  Thank you, Michelle  Michelle Monroe Contract Specialist / Client Relations Galaxy Health Network 2261 Brookhollow Plaza Drive Suite 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425 mmonroe@ghn-mci.com Phone (800) 975-3322 x1401 Fax directly (817)-394-2497\"  Replied with:  \"Hello Michelle,   I appreciate the reply and I apologize for the delay in responding back, please find the agreement, and here\'s the CAQH ID\'s for both providers:  Stephane Cyriaque:14189681 Shametria Tann: 15094779  I\'ve also attached all the required credentials for both providers for reference. Please let me know if anything else is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-07-08 13:00:38', '2021-07-08 13:00:38'),
(36527, 11056, 28437, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : mmonroe@ghn-mci.com  Sub :  Enrollment Status Query - Galaxy Health - BHUCC  Greetings,  Hope all is well. I wanted to inquire about the enrollment status and Galaxy participating agreement with the documents of the providers which we have submitted on 8th July,2021. Kindly update me with the enrollment status of the below mentioned providers and group.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 12:48:44', '2021-07-19 12:48:44'),
(36528, 11056, 28437, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from : cguerue@ghn-mci.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Galaxy Health ||  Good Morning, The information for Best Health Urgent Care & Clinic has been processed, we don’t subscribe to CAQH, so I am unable to access the information, however, Stephane Cyriaque has already been previously credentialed, so no other information will be needed, but we will need a copy of Shametria Tann’s CAQH forwarded to complete her credentialing.  Please feel free to contact me with any questions…  Thank you!  Christine Guerue Credentialing Dept  cguerue@ghn-mci.com 800-975-3322 x1130 817-633-5729 fax Galaxy Health Network 2261 Brookhollow Plaza Dr, Ste 106 Arlington, TX 76006 PO Box 201425 Arlington, TX 76006-1425', NULL, NULL, '2021-07-27 13:54:14', '2021-07-27 13:54:14'),
(36529, 11056, 28437, NULL, '2021-08-05 00:00:00.000', 'Approved', 'Approval Email received from : cguerue@ghn-mci.com  Sub : Enrollment Status || Best Health Urgent Care & Clinic || Tann, Shametria || Galaxy Health ||  Thank you Ahmed, this works perfectly and I have now marked all paperwork complete, the new group’s eff date is 7/27/21, providers Tann and Cyriaque will be linked to the group eff 7/27/21 as well.  Also, I have attached a copy of the fully executed agreement for your files.     Please feel free to contact me with any questions…  Thank you and have a good day!   The agreement has been attached. Please see the attachment.', NULL, NULL, '2021-07-28 15:58:00', '2021-07-28 15:58:00'),
(36530, 1006, 28438, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36531, 1006, 28438, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'We cannot proceed with this enrollment until Dr. Segun has been enrolled with Scott & White, as he is the supervising physician for the group. ', NULL, NULL, '2021-06-07 15:07:36', '2021-06-07 15:07:36'),
(36532, 1006, 28439, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36533, 1006, 28439, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Need to allow superior health enrollment to finish before submitting ambetter request, need to allow more time. ', NULL, NULL, '2021-06-07 09:15:52', '2021-06-07 09:15:52'),
(36534, 1006, 28440, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36535, 1006, 28440, NULL, '2021-06-04 00:00:00.000', 'Initiated', 'Sent following email @ trpndataentry@trpnppo.com & providerrelations@trpnppo.com:  Sub: Enrollment Request - BHUCC - TRPN  \"Hello,  We wish to enroll the following providers and group with TRPN, their information is as follows: Group Name: Best Health Urgent Care & ClinicNPI# 1013540962TIN# 84-4737737 Provider Name: Stephane Cyriaque NPI# 1780192633Enroll as: Specialist Provider Name: Shametria Tann NPI# 1124615612Enroll as: PCP Please let me know what else is required to process this request.  Thank you. \"', NULL, NULL, '2021-05-28 16:07:56', '2021-05-28 16:07:56'),
(36536, 3040, 28440, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email rcvd from: AVasquez@trpnppo.com  Subject: TRPN - Best Health Urgent Care & Clinic Hi Brad,   It was a pleasure speaking with you today.  Per our conversation, I am attaching a copy of our standard agreement for review and completion, please contact me directly with any questions and/or requests. I look forward to working with you.  Best regards,  Alex Vasquez Contract Coordinator 6970 O’Bannon Drive Las Vegas, Nevada 89117 Phone: (619) 271-2708 Fax: (619) 271-2587 avasquez@trpnppo.com www.trpnppo.com ', NULL, NULL, '2021-06-09 16:08:21', '2021-06-09 16:08:21'),
(36537, 1006, 28440, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Replied to Alejandro with the agreement @ Alejandro Vasquez AVasquez@trpnppo.com:  Sub: FW: TRPN - Best Health Urgent Care & Clinic  \"Hello Alejandro,  Appreciate the reply, here\'s the filled-out agreement. Please let me know what else might be needed to proceed further with this process.  Thank you. \"  Agreement is attached in group task for reference as it is an ancillary contract request. ', NULL, NULL, '2021-06-09 16:25:04', '2021-06-09 16:25:04'),
(36538, 11056, 28440, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com  Sub : TRPN - Best Health Urgent Care & Clinic  Hi Brad,   I will have the agreement executed and a countersigned copy will be sent to you for your records, the time frame for completion is three to four weeks, but feel free to follow up with me at any time.   Thank you and have a great weekend!', NULL, NULL, '2021-06-28 12:58:57', '2021-06-28 12:58:57'),
(36539, 11056, 28440, NULL, '2021-07-19 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : Enrollment Status Update - Best Health Urgent Care & Clinic - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 3-4 weeks but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.   Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-12 12:57:47', '2021-07-12 12:57:47'),
(36540, 11056, 28440, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email sent to : AVasquez@trpnppo.com  Sub : AGREEMENT DEMAND - BHUCC - TRPN  Greetings,  Hope you are doing well. This is a follow-up email for the agreement which you were going to send us in 4-5 weeks ago but the time frame has been completed and we haven\'t got the agreement yet. Kindly respond to us soon. We are eagerly waiting for your response and agreement.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice NPI # : 1013540962 Practice TIN # : 84-4737737 Practice Address : 3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider: Provider Name : Stephane Cyriaque Provider  NPI # : 1780192633  Provider Name : Shametria Tann Provider  NPI # : 1124615612  If you need any information or documents feel free to reach out to us. Waiting to hear from you soon.  Thank you! Have a great day!', NULL, NULL, '2021-07-19 10:47:32', '2021-07-19 10:47:32'),
(36541, 11056, 28440, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : AVasquez@trpnppo.com via trpnppo.onmicrosoft.com   Sub : Automatic reply: AGREEMENT DEMAND - BHUCC - TRPN  I will be out of the office starting Mondy, July 19 and I will return all calls/emails upon my return on Wednesday, July 21. Thank you!', NULL, NULL, '2021-07-30 12:44:50', '2021-07-30 12:44:50'),
(36542, 11056, 28440, NULL, '2021-08-11 00:00:00.000', 'Approved', 'Approval Email received from : kfry@trpnppo.com  &  avasquez@trpnppo.com  Sub : Welcome to Three Rivers Provider Network.  Welcome to Three Rivers Provider Network.  Please see your attached welcome letter and executed agreement.  Please reach out if you need anything else.  Thank you  Kellyn Fry Data Entry Coordinator/Office Assistant 6970 O’ Bannon Drive Las Vegas, NV 89117 Phone:(619) 600-4808 Fax: (619) 271-2658 Primary Email: kfry@trpnppo.com', NULL, NULL, '2021-08-04 13:28:12', '2021-08-04 13:28:12'),
(36543, 1006, 28441, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36544, 1006, 28441, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Group does not fall under Driscoll\'s service area: \"From: Melinda.Lopez@dchstx.org Sub: Request for Contract Stephane Cyriaque FNP  Hello Samuel, I want to acknowledge receipt of the completed request for contract form submitted for Stephane Cyriaque FNP however cannot process due to Missouri City TX is not in our service area and we do not have any members that reside in this area.  The request for contract is being withdrawn due to not in our service area. Please refer to the map below of the 24 counties within our service area.\"', NULL, NULL, '2021-06-07 15:08:55', '2021-06-07 15:08:55'),
(36545, 1006, 28442, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36546, 1006, 28442, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent following enrollment initiation request @ CSHNproviderrelations@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Spohn   \"Hello, We wish to enroll the following group and providers with Christus Spohn, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please let me know what is required to proceed with this process.  Thank you. \"', NULL, NULL, '2021-06-07 10:47:25', '2021-06-07 10:47:25'),
(36547, 1006, 28442, NULL, '2021-07-01 00:00:00.000', 'Not Eligible', 'Christus Spohn service area does not cover Missouri City/Fort Bend County: https://www.christushealth.org/spohn/patient-resources/spohn-health-network/service-area', NULL, NULL, '2021-06-24 13:43:37', '2021-06-24 13:43:37'),
(36548, 1006, 28443, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36549, 1006, 28443, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Ancillary enrollment is in-process in the main group task, please check it for further information. ', NULL, NULL, '2021-06-07 14:14:18', '2021-06-07 14:14:18'),
(36550, 11056, 28443, NULL, '2021-07-20 00:00:00.000', 'In Process', 'Email sent to : TXMAContracting@cigna.com  Sub : Enrollment Query - BHUCC - Cigna Healthspring  Good Evening,  Hope you are doing well. I wanted to get an update regarding the enrollment request we submitted for our group, please let me know what the current status is? Kindly respond to us soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B  MISSOURI CITY , TX 77489-5242  If you need any information or documents feel free to contact us. Waiting for your response.  Thank you!', NULL, NULL, '2021-07-12 14:44:40', '2021-07-12 14:44:40'),
(36551, 11056, 28443, NULL, '2021-07-20 00:00:00.000', 'On Hold', 'Ancillary enrollment is in-process in the main group task, please check it for further information. ', NULL, NULL, '2021-07-12 14:45:21', '2021-07-12 14:45:21'),
(36552, 1006, 28444, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36553, 1006, 28444, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'This is pending UHC enrollment, need to allow more time. ', NULL, NULL, '2021-06-07 09:24:22', '2021-06-07 09:24:22'),
(36554, 11056, 28444, NULL, '2021-07-20 00:00:00.000', 'Initiated', 'Greetings,  Hope you are doing well. I want to enroll the below mentioned provider and Group. Kindly guide me with the procedure how to enroll them.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.    Thank you! Have a great day!', NULL, NULL, '2021-07-12 17:03:26', '2021-07-12 17:03:26'),
(36555, 11056, 28444, NULL, '2021-07-20 00:00:00.000', 'Initiated', 'Email sent to : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Greetings,  Hope you are doing well. I want to enroll the below mentioned provider and Group. Kindly guide me with the procedure how to enroll them.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.    Thank you! Have a great day!', NULL, NULL, '2021-07-12 17:04:52', '2021-07-12 17:04:52'),
(36556, 11056, 28444, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email received from : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Hello,     Thank you for reaching out to UnitedHealth Care.  I’ll be happy to assist you today. I reviewed  TANN, SHAMETRIA  - 7674348 /TAX ID 844737737 regarding enrolling group and provider. Per your provider’s profile, I can confirm that group is enrolled, and the provider is linked to the group, waiting to be added to group contract. Open phycon add to group PR-5925454 being work on. Need more time to complete, 30 days.     Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. Have a wonderful day!     Thank You,     Aldean Mosley  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-15 15:57:20', '2021-07-15 15:57:20'),
(36557, 11056, 28444, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : aldean_mosley@uhc.com  & networkhelp@uhc.com  Sub : Secure Message from aldean_mosley@uhc.com  Hello,  Thank you for reaching back out to UnitedHealth Care.  I submitted an escalation today requesting that provider be added to group contract, load contract lines, ETA 10 days, there is nothing additional required of you other than following up in 10 days to check the contract status for the provider.     Let us know if you need further assistance.  Please send all responses or questions pertaining to this email to networkhelp@uhc.com. Have a wonderful day!  Thank You, Aldean Mosley UnitedHealthcare Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-23 12:28:49', '2021-07-23 12:28:49'),
(36558, 11056, 28444, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email received from  : networkhelp@uhc.com  Sub : Secure Message from katherine_k_floyd@uhc.com  Good afternoon Ahmed,    SHAMETRIA TANN  has had two request for credentialing. Is this provider not a urgent care seeing walk-ins or seeing patients by appointment?  Walk-in providers do not require credentialing by appointment does.     Thank you.     Katherine Floyd  UnitedHealthcare  Network Management Resource Team (NMRT)', NULL, NULL, '2021-07-27 10:57:13', '2021-07-27 10:57:13'),
(36559, 11056, 28444, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	networkhelp@uhc.com  Sub :  ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned provider and Group for UHC Plan (Texas Star Kids). Kindly provide me with the updates soon.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address : 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-08-04 08:35:02', '2021-08-04 08:35:02'),
(36560, 11056, 28444, NULL, '2021-08-18 00:00:00.000', 'In Process', 'Email sent to : 	networkhelp@uhc.com  Sub :  ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Good morning!  Hope you are doing well. I want to know the enrollment status of the below mentioned provider and Group for UHC Plan (Texas Star Kids). Kindly provide me with the updates soon.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address : 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   Provider Details: Provider Name : Tann, Shametria Provider NPI # : 1124615612   If you need any information please feel free to call or email me. Waiting for your response.   Thank you! Have a great day!', NULL, NULL, '2021-08-10 14:40:03', '2021-08-10 14:40:03'),
(36561, 11056, 28444, NULL, '2021-08-24 00:00:00.000', 'In Process', 'Approval Email received from : networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Hi Talha  Thank you for emailing Network help.  The Group and Provider has been updated with  UHC Plan (Texas Star Kids) plan.   Attached is the Product code list.   Thanks Pam  Pamela(Pam) Preece UnitedHealthcare Network Management Resource Team (NMRT)   Eff date is : 07/20/2021', NULL, NULL, '2021-08-16 14:22:04', '2021-08-16 14:22:04'),
(36562, 11056, 28444, NULL, '2021-08-24 00:00:00.000', 'Approved', 'Approval Email received from :   networkhelp@uhc.com  Sub : ENROLLMENT REQUEST - BHUCC - UHC Plan (Texas Star Kids)  Hi Talha  Thank you for emailing Network help.  The Group and Provider has been updated with  UHC Plan (Texas Star Kids) plan.   Attached is the Product code list.   Thanks Pam  Pamela(Pam) Preece UnitedHealthcare Network Management Resource Team (NMRT)   Eff date is : 07/20/2021', NULL, NULL, '2021-08-16 14:23:44', '2021-08-16 14:23:44'),
(36563, 1006, 28445, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36564, 1006, 28445, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment and f/u request @ credentialing@anci-care.com:  Sub: Enrollment Request/Status - BHUCC - Anci-Care  \"Hello,  I wanted to know what is required to get the following group and providers enrolled with Anci-Care, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please get back to me as soon as possible regarding this. Thank you. \"', NULL, NULL, '2021-06-07 10:31:01', '2021-06-07 10:31:01'),
(36565, 1006, 28445, NULL, '2021-07-01 00:00:00.000', 'In Process', 'Sent following reply to Patti DavidsonACS pdavidson@anci-care.com:  Sub; New Provider Agreement - per request  \"Hello Patti,  Please find the attached information as requested, do let me know if anything else is required to proceed with this process.  Thank you!\"  Documents are attached for reference in main group task. ', NULL, NULL, '2021-06-24 13:40:44', '2021-06-24 13:40:44'),
(36566, 11056, 28445, NULL, '2021-07-14 00:00:00.000', 'In Process', 'Email received from :  pdavidson@anci-care.com  Sub : New Provider Agreement - per request  Hi.  Thank you!  I have submitted all documents on for credentialing approval.  Once approved you will receive a welcome letter and signed provider agreement from Jennifer Maligaya- Sr. PR Rep.  Thank you,  Patti Davidson | Manager, Network Development HealthSmart | Network Solutions Office: 972 388 3091 | Fax: 214 574 1121 patti.davidson@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-06 16:23:55', '2021-07-06 16:23:55'),
(36567, 11056, 28445, NULL, '2021-07-23 00:00:00.000', 'In Process', 'Email sent to : pdavidson@anci-care.com  Sub :  New Provider Agreement - per request  Good Afternoon Patti,    Hope you are doing well. I want to inquire about the enrollment status of the below mentioned providers and group in Anci care. When will you gonna provide the letter welcome letter and signed provider agreement.    Practice Details:  Practice Name: Best Health Urgent Care & Clinic Practice NPI# 1013540962  Practice TIN# 84-4737737     Providers:   Provider Name: Stephane Cyriaque NPI# 1780192633     Provider Name: Shametria Tann NPI# 1124615612     Please get back to me as soon as possible regarding this.Feel free to reach out to me if you have any questions.     Thank you!', NULL, NULL, '2021-07-15 14:06:03', '2021-07-15 14:06:03'),
(36568, 11056, 28445, NULL, '2021-07-30 00:00:00.000', 'In Process', 'Email received from : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Good Morning,  BEST HEALTH URGENT CARE & CLINIC, TIN 844737737 is contracted with ACS. Please note, ACS credentials/recredentials the location, not individuals. Therefore, if the providers invoice with the same TIN, they are considered in network with ACS.  Best Regards,  Jennifer Maligaya | Sr. Provider Relations, ACS and MyDecision HealthSmart | Network Solutions Office: 405 241 4811 | Fax: 214 574 1121 Jennifer.maligaya@healthsmart.com | www.HealthSmart.com', NULL, NULL, '2021-07-23 10:20:18', '2021-07-23 10:20:18'),
(36569, 11056, 28445, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Email sent to : Jennifer.Maligaya@healthsmart.com  Sub : New Provider Agreement - per request  Greetings,  Hope all is well. Yeah the provider invoice with the same TIN of the practice BEST HEALTH URGENT CARE & CLINIC. Thank you for the clarification.  Thank you! Have a great day!', NULL, NULL, '2021-07-26 11:30:58', '2021-07-26 11:30:58'),
(36570, 11056, 28445, NULL, '2021-08-05 00:00:00.000', 'Approved', '	 APPROVAL Email received from : 	\'Jennifer Maligaya\' via Best Health Urgent Care & Clinic, PLLC   Jennifer.Maligaya@healthsmart.com  Sub : Welcome to ACS, Best Health Urgent Care & Clinic  Good Afternoon,     Congratulations and welcome to the Ancillary Care Services (ACS) network. Please see the attachments. My name is Jennifer Maligaya and I am the Sr. Provider Relations Representative to the ACS Providers.     My contact information is listed below my signature. Please do not hesitate to reach out to me with any questions or concerns. Thank you!     Best Regards,     Jennifer Maligaya | Sr. Provider Relations Representative  HealthSmart | Network Solutions  Office: 405 241 4811 | Fax: 214 574 1121  Jennifer.maligaya@healthsmart.com | www.HealthSmart.com   The agreement is attached .Please see the attachment.', NULL, NULL, '2021-07-28 14:39:01', '2021-07-28 14:39:01'),
(36571, 1006, 28446, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:45:59', '2021-05-06 07:45:59'),
(36572, 1006, 28446, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'Our request is in-process but we still haven\'t received a contract and it is based on the need for providers and the amount of VA patients in the area, we need to wait until we are eligible. Need to wait until we receive a contract from them to proceed with this application.  Ref# Kate 06/07/2021', NULL, NULL, '2021-06-07 11:41:56', '2021-06-07 11:41:56'),
(36573, 1006, 28447, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:46:00', '2021-05-06 07:46:00'),
(36574, 1006, 28447, NULL, '2021-06-04 00:00:00.000', 'Not Eligible', 'The insurance is not eligible for enrollment as per our discussion with the billing teams.', NULL, NULL, '2021-05-28 17:01:06', '2021-05-28 17:01:06'),
(36575, 1006, 28459, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:46:00', '2021-05-06 07:46:00'),
(36576, 1006, 28459, NULL, '2021-06-14 00:00:00.000', 'Not Eligible', 'Renaissance Physicians does not cover Missouri City for enrollment requests. We cannot move forward.', NULL, NULL, '2021-06-07 10:58:14', '2021-06-07 10:58:14'),
(36577, 1006, 28460, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:46:00', '2021-05-06 07:46:00'),
(36578, 1006, 28460, NULL, '2021-06-14 00:00:00.000', 'On Hold', 'The request is in process in the main Molina task, need to allow more time. ', NULL, NULL, '2021-06-07 16:10:35', '2021-06-07 16:10:35'),
(36579, 11056, 28460, NULL, '2021-11-17 00:00:00.000', 'In Process', 'Email sent to  : MHTContractrequest@molinahealthcare.com  Sub : Molina Provider Contracting - Shametria Tann  Good morning!     Hope this email finds you well. Please let me know about the procedure to link the following provider to the group & location mentioned below in the group contract. Group contract & roster has been attached. Please see the attachments.        Group Name  Best Health Urgent Care & Clinic  Tax ID  84-4737737  Group NPI  1013540962  Primary Location  3003 TEXAS PKWY UNIT B, MISSOURI CITY , TX 77489-5242  Provider Name  NPI  Shametria Tann  ( FNP )  1124615612    If you have any questions or require additional information or documents please let me know.      Thank you!  Have a great day!', NULL, NULL, '2021-11-10 16:59:58', '2021-11-10 16:59:58'),
(36580, 11056, 28460, NULL, '2021-12-06 00:00:00.000', 'In Process', 'Email received from: MHTContractrequest@molinahealthcare.com  Sub:   Enrollment Query - BHUCC - MOLINA MARKETPLACE  Good Afternoon,     Happy Wednesday! - Thank you for your interest in becoming part of the Molina Healthcare network.  I have been assigned the intake of your request to contract with Molina Healthcare of Texas.         Please Note: In order for the contract process to start, we will need a copy of the W9 form.      Please send back both forms to this email once completed.     Also, please advise if the group is an Urgent Care or a Group of Providers.     Thank you in advance!        Best Regards,     Provider Contract Coordination Department | JG   Molina Healthcare of Texas, Inc.    Form has been submitted.', NULL, NULL, '2021-11-29 09:20:30', '2021-11-29 09:20:30'),
(36581, 11056, 28460, NULL, '2021-12-21 00:00:00.000', 'Approved', 'Approval email received from : MHTContractrequest@molinahealthcare.com  Sub : Enrollment Request - BHUCC - Molina  Good morning,  Happy Tuesday!!  Thank you for your interest in joining Molina healthcare network.  I have received your contract request form, however, I noticed pay to NPI number belongs to urgent care.  Molina does not contract individual providers to urgent care.  Molina contract urgent care itself.  I also show facility is already contracted with Molina healthcare effective date 10/1/2020.  Thank you  Juliana Mata | Associate Specialist Provider Contracts Molina Healthcare Of Texas Molina Healthcare Of Texas, Inc Juliana.Mata@Molinahealthcare.com 1660 Westridge Circle N. Irving, TX 75038 \'  (888) 562-5442 ext 200249    Received Urgent Care Contract for the practice effective 10/01/2020. Placed on the server and uploaded on EMRBS. As the facility is now contracted as and Urgent Care with molina so all the practicing providers will be considered in-network.', NULL, NULL, '2021-12-14 16:50:17', '2021-12-14 16:50:17'),
(36582, 1006, 28461, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 07:46:00', '2021-05-06 07:46:00'),
(36583, 1006, 28461, NULL, '2021-06-14 00:00:00.000', 'Initiated', 'Sent enrollment request @ \"Simms, Michal\" michal.simms@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Hello Michal, I hope you\'re doing well, we wish to enroll the following group and providers with Christus Health, their information is as follows:  Group Name: Best Health Urgent Care & Clinic NPI# 1013540962 TIN# 84-4737737  Provider Name: Stephane Cyriaque NPI# 1780192633  Provider Name: Shametria Tann NPI# 1124615612  Please let me know what is required to proceed with this request.  Thank you. \"', NULL, NULL, '2021-06-07 10:49:35', '2021-06-07 10:49:35'),
(36584, 1006, 28461, NULL, '2021-06-22 00:00:00.000', 'In Process', 'We received the following reply from Hunter Barrett hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Brad,  Does the urgent care bill on a professional level, billing with the individuals NPI or as the group NPI?  Thanks,\"  Gave them the following reply: \"Good morning Hunter,   The urgent care bills with individual NPI\'s. Also, we want one of the providers to be listed as a PCP, is that possible?  Thank you.\"', NULL, NULL, '2021-06-15 08:06:06', '2021-06-15 08:06:06'),
(36585, 1006, 28461, NULL, '2021-07-12 00:00:00.000', 'In Process', 'We received the following reply hunter.barrett@christushealth.org:  Sub: Enrollment Request - BHUCC - Christus Health  \"Does the provider have a separate office?  Thanks,  Hunter Barrett Network Contracting CHRISTUS Health Plan CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113 www.christushealth.org\"  Replied with:   \"Hello Hunter,  I apologize for the delay, but no the provider will be working in the same office. Please let me know if there\'s any way to enroll her as a PCP.  Thank you. \"', NULL, NULL, '2021-07-05 16:54:38', '2021-07-05 16:54:38'),
(36586, 11056, 28461, NULL, '2021-07-26 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Brad,   After talking with my manager, we cannot contract with an Urgent Care Center with a group contract, the only way the center can become in network is with an Ancillary contract and only the group NPI will show up as in network and can only bill as the group NPI.   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, '2021-07-19 10:37:56', '2021-07-19 10:37:56'),
(36587, 11056, 28461, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Good Afternoon!  Hope you are doing well. Ok, then kindly inform me with Ancillary contract procedure and guide me with that properly soon. What steps do I have to take and which documents you required for enrollment in the Ancillary contract?  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-26 15:48:31', '2021-07-26 15:48:31'),
(36588, 11056, 28461, NULL, '2021-08-03 00:00:00.000', 'In Process', 'Email sent to : hunter.barrett@christushealth.org  Sub : Enrollment Request - BHUCC - Christus Health  Good Afternoon!  Hope you are doing well. Ok, then kindly inform me with Ancillary contract procedure and guide me with that properly soon. What steps do I have to take and which documents you required for enrollment in the Ancillary contract?  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you need any details please let me know. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-07-26 15:48:31', '2021-07-26 15:48:31'),
(36589, 11056, 28461, NULL, '2021-08-06 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,  I apologize, I thought I sent the documents. Here is the contract and application needed.  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, '2021-07-29 17:06:22', '2021-07-29 17:06:22'),
(36590, 11056, 28461, NULL, '2021-08-11 00:00:00.000', 'In Process', '	 Email sent to : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope you are doing well. Here is the filled contract/agreement and application forms for the providers and practice mentioned below. Please see the attachment.   Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a Great Day!', NULL, NULL, '2021-08-03 15:18:58', '2021-08-03 15:18:58'),
(36591, 11056, 28461, NULL, '2021-08-17 00:00:00.000', 'In Process', 'Email received from : hunter.barrett@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Ahmed,   Do you have a copy of the W9?   Thanks,   Hunter Barrett Network Contracting CHRISTUS Health Plan  CHRISTUS Health 919 Hidden Ridge | Irving, Texas 75038 (o) 469.282.3113', NULL, NULL, '2021-08-10 08:31:54', '2021-08-10 08:31:54'),
(36592, 11056, 28461, NULL, '2021-09-02 00:00:00.000', 'In Process', 'The request will take 6 months because their credentialing team is packed with some old providers and work, it will take 6 months to enroll new providers..', NULL, NULL, '2021-08-25 17:03:11', '2021-08-25 17:03:11'),
(36593, 11056, 28461, NULL, '2021-09-08 00:00:00.000', 'In Process', 'Email sent to : christus.hp.credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health  Good afternoon Hunter!  Hope this email finds you well. It\'s been a long time sir, that you haven\'t responded to my emails. Please inform me about the enrollment status of the mentioned below providers and Practice.  Practice Details: Practice Name : Best Health Urgent Care & Clinic Practice Tax ID # : 84-4737737 Practice NPI # : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242  Provider Details: Provider 1: Provider Name : Tann, Shametria Provider NPI # : 1124615612  Provider 2: Provider Name : Cyriaque, Stephane Provider NPI # : 1780192633  If you have questions or need documents or information feel free to reach out to me. Waiting for your response, eagerly.  Thank you! Have a great week ahead!', NULL, NULL, '2021-08-31 16:21:26', '2021-08-31 16:21:26'),
(36594, 11056, 28461, NULL, '2021-10-04 00:00:00.000', 'On Hold', 'Email received from : hunter.barrett@christushealth.org  &  CHRISTUS.HP.Credentialing@christushealth.org  Sub : RE: Enrollment Request - BHUCC - Christus Health   I have been on Vacation. Contract was sent to credentialing at the beginning of August. They hast to give them 6 months to process new applications.', NULL, NULL, '2021-09-27 08:26:53', '2021-09-27 08:26:53'),
(36595, 1006, 28462, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 12:05:35', '2021-05-06 12:05:35'),
(36596, 1006, 28462, NULL, '2021-05-16 00:00:00.000', 'Initiated', 'Ancillary enrollment request is in process for the group. ', NULL, NULL, '2021-05-06 13:30:39', '2021-05-06 13:30:39'),
(36597, 1006, 28462, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent a f/u email @ Michelle Bangert mbangert@wellmed.net:  Sub: Re: Missing Documents -WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic  \"Hello Michelle,   I hope you\'re doing well, I wanted to verify if there\'s anything else that\'s required and how long will enrollment take?  Thank you.\"', NULL, NULL, '2021-05-11 07:19:27', '2021-05-11 07:19:27'),
(36598, 1006, 28462, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We received the following reply from Michelle Bangert mbangert@wellmed.net:  Sub: WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  \"Good Morning,  Can you please resend the ancillary application using the name exactly as it appears on the W9? My corporate office will not be able to process the group’s contract without the correction listed below. My apologies for any inconvenience.  Thank you\"  Replied with:  \"Hello Michelle,  I hope you\'re doing well, I had already sent you an updated copy with the corrected W9 on May 18th. Did that not suffice?  Thank you.\"  ', NULL, NULL, '2021-05-28 11:18:02', '2021-05-28 11:18:02');
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
(36599, 3040, 28462, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: mbangert@wellmed.net  Subject: WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  Hello Michelle,   I just wanted to check in with you again regarding this, could you please let me know how we should proceed?  Thank you', NULL, NULL, '2021-06-09 16:15:34', '2021-06-09 16:15:34'),
(36600, 11056, 28462, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to :    mbangert@wellmed.net  Sub : WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  Good morning!  Hope you are doing well. Please see the attachment. If you need any further information please let me know.  Have a great day!', NULL, NULL, '2021-06-28 10:50:18', '2021-06-28 10:50:18'),
(36601, 11056, 28462, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good evening!  Hope you are doing well. Kindly update me on the enrollment status of the following providers and Group. Kindly inform me regarding the Ancillary Applications which i had submitted to you 2 weeks ago. Kindly respond to this email, eagerly waiting for your response.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633   If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!', NULL, NULL, '2021-07-13 16:40:37', '2021-07-13 16:40:37'),
(36602, 11056, 28462, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : bcole1@wellmed.net  Sub : Credentialing for Best Health Urgent Care & Clinic  Good Morning,  I’m reaching out because we are currently processing the credentialing file for Best Health Urgent Care & Clinic, and we require some additional information before we can complete the credentialing process. Please provide or clarify the following items:  • The liability insurance that was provided with the application is for an individual provider. Please provide a copy of the liability insurance for the facility.  If you have any questions regarding the requested information above, please contact Cody Dodgen at: cododgen@wellmed.net or (210) 951-3092. I appreciate your assistance.  My Regards, Bianca Cole Sr. Provider Service & Experience Manager WellMed Medical Management, Inc. O +1 (832) 973-8154', NULL, NULL, '2021-07-20 10:44:35', '2021-07-20 10:44:35'),
(36603, 1006, 28462, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Replied with the requested information @ cododgen@wellmed.net & bcole1@wellmed.net:  \"Hello Cody,   Please find the attached COI, it covers both the provider and the facility. Do let me know if this is sufficient.  Thank you. \"', NULL, NULL, '2021-07-26 08:20:00', '2021-07-26 08:20:00'),
(36604, 11056, 28462, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	cododgen@wellmed.net    &   bcole1@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Bianca!  Hope you are doing well. Please accept my apology for the last email. Here is the copy of the liability insurance for the facility you requested for. Kindly see the attachment.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   If you need any additional information or documents please feel free to reach out to me soon. Waiting for your response.  Thank you! Have a Great week ahead!', NULL, NULL, '2021-08-04 08:46:22', '2021-08-04 08:46:22'),
(36605, 11056, 28462, NULL, '2021-08-22 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Morning,     Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-10 14:46:57', '2021-08-10 14:46:57'),
(36606, 11056, 28462, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Michelle!  Hope all is well. I wanted to inquire about the enrollment status of the provider and group. Kindly update me with the enrollment status of the below mentioned provider and group soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!  I have tried to reach out through call but she is working from home. And recorder just allowed me to left out the voice message for her about the issue.', NULL, NULL, '2021-08-16 11:35:19', '2021-08-16 11:35:19'),
(36607, 11056, 28462, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good afternoon. As of 8/16 the group is still in credentialing. Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you for your continued patience.     Thank you,  Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-23 14:25:42', '2021-08-23 14:25:42'),
(36608, 11056, 28462, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Hey Michelle!  Hope this email finds you well. You have already informed me about this about 60-90 days for credentialing on 14 of July,2021. Now you are saying the same.  Please provide me with the latest updates soon. And inform me with the exact time frame for the process.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-31 11:04:20', '2021-08-31 11:04:20'),
(36609, 11056, 28462, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Afternoon.     As of 8/25 the group is still in process. WellMed loading and credentialing commenced 6/8/2021and can take 60-90 days for completion. The Best Health UC is not presently loaded in WellMed’s system for UC services under the WellMed agreement as of today.     The completion time may vary based on volume of contracts in the processing queue and may vary if any unforeseen items occur in the credentialing process.     The group is presently in the usual and customary time frame and no further updates will become available until after 9/8/2021. However the group may be contacted directly by WellMed Contracting and Credentialing Department for any missing information that may delay the loading process.     Thank you for your continued patience.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-09-08 14:47:46', '2021-09-08 14:47:46'),
(36610, 11056, 28462, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Approval Email received from : mbangert@wellmed.net  Sub  : RE: [EXTERNAL] Re: Enrollment Request Application - BHUCC - WellMed - effective WM PAR 9/1/2021  The Group BHUCC is WellMed PAR and effective for Houston as of 09/01/2021.  Ancillary providers are not loaded individually. The group TIN has been confirmed PAR.', NULL, NULL, '2021-09-09 16:22:21', '2021-09-09 16:22:21'),
(36611, 1006, 28463, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 12:05:35', '2021-05-06 12:05:35'),
(36612, 1006, 28463, NULL, '2021-05-16 00:00:00.000', 'Initiated', 'Ancillary enrollment request is in process for the group. ', NULL, NULL, '2021-05-06 13:31:04', '2021-05-06 13:31:04'),
(36613, 3040, 28463, NULL, '2021-06-16 00:00:00.000', 'On Hold', 'Ancillary enrollment request is in process for the group.  ', NULL, NULL, '2021-06-09 15:56:29', '2021-06-09 15:56:29'),
(36614, 11056, 28463, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to :    mbangert@wellmed.net  Sub : WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  Good morning!  Hope you are doing well. Please see the attachment. If you need any further information please let me know.  Have a great day!', NULL, NULL, '2021-06-28 10:49:47', '2021-06-28 10:49:47'),
(36615, 11056, 28463, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good evening!  Hope you are doing well. Kindly update me on the enrollment status of the following providers and Group. Kindly inform me regarding the Ancillary Applications which i had submitted to you 2 weeks ago. Kindly respond to this email, eagerly waiting for your response.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633   If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!', NULL, NULL, '2021-07-13 16:41:03', '2021-07-13 16:41:03'),
(36616, 11056, 28463, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : bcole1@wellmed.net  Sub : Credentialing for Best Health Urgent Care & Clinic  Good Morning,  I’m reaching out because we are currently processing the credentialing file for Best Health Urgent Care & Clinic, and we require some additional information before we can complete the credentialing process. Please provide or clarify the following items:  • The liability insurance that was provided with the application is for an individual provider. Please provide a copy of the liability insurance for the facility.  If you have any questions regarding the requested information above, please contact Cody Dodgen at: cododgen@wellmed.net or (210) 951-3092. I appreciate your assistance.  My Regards, Bianca Cole Sr. Provider Service & Experience Manager WellMed Medical Management, Inc. O +1 (832) 973-8154', NULL, NULL, '2021-07-20 10:44:26', '2021-07-20 10:44:26'),
(36617, 1006, 28463, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Replied with the requested information @ cododgen@wellmed.net & bcole1@wellmed.net:  \"Hello Cody,   Please find the attached COI, it covers both the provider and the facility. Do let me know if this is sufficient.  Thank you. \"', NULL, NULL, '2021-07-26 08:19:57', '2021-07-26 08:19:57'),
(36618, 11056, 28463, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	cododgen@wellmed.net    &   bcole1@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Bianca!  Hope you are doing well. Please accept my apology for the last email. Here is the copy of the liability insurance for the facility you requested for. Kindly see the attachment.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   If you need any additional information or documents please feel free to reach out to me soon. Waiting for your response.  Thank you! Have a Great week ahead!', NULL, NULL, '2021-08-04 08:46:13', '2021-08-04 08:46:13'),
(36619, 11056, 28463, NULL, '2021-08-22 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Morning,     Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-10 14:46:39', '2021-08-10 14:46:39'),
(36620, 11056, 28463, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Michelle!  Hope all is well. I wanted to inquire about the enrollment status of the provider and group. Kindly update me with the enrollment status of the below mentioned provider and group soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!  I have tried to reach out through call but she is working from home. And recorder just allowed me to left out the voice message for her about the issue.', NULL, NULL, '2021-08-16 11:35:13', '2021-08-16 11:35:13'),
(36621, 11056, 28463, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good afternoon. As of 8/16 the group is still in credentialing. Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you for your continued patience.     Thank you,  Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-23 14:25:35', '2021-08-23 14:25:35'),
(36622, 11056, 28463, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Hey Michelle!  Hope this email finds you well. You have already informed me about this about 60-90 days for credentialing on 14 of July,2021. Now you are saying the same.  Please provide me with the latest updates soon. And inform me with the exact time frame for the process.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-31 11:04:14', '2021-08-31 11:04:14'),
(36623, 11056, 28463, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Afternoon.     As of 8/25 the group is still in process. WellMed loading and credentialing commenced 6/8/2021and can take 60-90 days for completion. The Best Health UC is not presently loaded in WellMed’s system for UC services under the WellMed agreement as of today.     The completion time may vary based on volume of contracts in the processing queue and may vary if any unforeseen items occur in the credentialing process.     The group is presently in the usual and customary time frame and no further updates will become available until after 9/8/2021. However the group may be contacted directly by WellMed Contracting and Credentialing Department for any missing information that may delay the loading process.     Thank you for your continued patience.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-09-08 14:47:36', '2021-09-08 14:47:36'),
(36624, 11056, 28463, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Approval Email received from : mbangert@wellmed.net  Sub  : RE: [EXTERNAL] Re: Enrollment Request Application - BHUCC - WellMed - effective WM PAR 9/1/2021  The Group BHUCC is WellMed PAR and effective for Houston as of 09/01/2021.  Ancillary providers are not loaded individually. The group TIN has been confirmed PAR.', NULL, NULL, '2021-09-09 16:22:05', '2021-09-09 16:22:05'),
(36625, 1006, 28464, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 12:05:39', '2021-05-06 12:05:39'),
(36626, 1006, 28464, NULL, '2021-05-16 00:00:00.000', 'Initiated', 'Received the following email from Michelle Bangert mbangert@wellmed.net:  Sub: Re: Missing Documents -WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic  \"Hi Brad,  WellMed is missing the supporting documentation for the ancillary application. Please complete and return the ancillary application and include all supporting documentation for processing. Thank you for your attention to this matter.  Thank you,  Michelle Bangert, Sr. Contract Consultant Manager Ph.: 1-813-767-5236| MBangert@WellMed.net\"  Ancillary application submitted to rep.', NULL, NULL, '2021-05-06 13:29:36', '2021-05-06 13:29:36'),
(36627, 1006, 28464, NULL, '2021-05-21 00:00:00.000', 'In Process', 'Sent a f/u email @ Michelle Bangert mbangert@wellmed.net:  Sub: Re: Missing Documents -WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic  \"Hello Michelle,   I hope you\'re doing well, I wanted to verify if there\'s anything else that\'s required and how long will enrollment take?  Thank you.\"', NULL, NULL, '2021-05-11 07:19:57', '2021-05-11 07:19:57'),
(36628, 1006, 28464, NULL, '2021-06-04 00:00:00.000', 'In Process', 'We received the following reply from Michelle Bangert mbangert@wellmed.net:  Sub: WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  \"Good Morning,  Can you please resend the ancillary application using the name exactly as it appears on the W9? My corporate office will not be able to process the group’s contract without the correction listed below. My apologies for any inconvenience.  Thank you\"  Replied with:  \"Hello Michelle,  I hope you\'re doing well, I had already sent you an updated copy with the corrected W9 on May 18th. Did that not suffice?  Thank you.\"  ', NULL, NULL, '2021-05-28 11:17:38', '2021-05-28 11:17:38'),
(36629, 3040, 28464, NULL, '2021-06-16 00:00:00.000', 'In Process', 'Email sent to: mbangert@wellmed.net  Subject: WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  Hello Michelle,   I just wanted to check in with you again regarding this, could you please let me know how we should proceed?  Thank you', NULL, NULL, '2021-06-09 16:15:38', '2021-06-09 16:15:38'),
(36630, 11056, 28464, NULL, '2021-07-05 00:00:00.000', 'In Process', 'Email sent to :    mbangert@wellmed.net  Sub : WellMed - Stephanie Cyriaque dba Best Health Urgent Care & Clinic - missing/incomplete - requested 5/28  Good morning!  Hope you are doing well. Please see the attachment. If you need any further information please let me know.  Have a great day!', NULL, NULL, '2021-06-28 10:50:35', '2021-06-28 10:50:35'),
(36631, 11056, 28464, NULL, '2021-07-21 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good evening!  Hope you are doing well. Kindly update me on the enrollment status of the following providers and Group. Kindly inform me regarding the Ancillary Applications which i had submitted to you 2 weeks ago. Kindly respond to this email, eagerly waiting for your response.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633   If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!', NULL, NULL, '2021-07-13 16:41:10', '2021-07-13 16:41:10'),
(36632, 11056, 28464, NULL, '2021-07-27 00:00:00.000', 'In Process', 'Email received from : bcole1@wellmed.net  Sub : Credentialing for Best Health Urgent Care & Clinic  Good Morning,  I’m reaching out because we are currently processing the credentialing file for Best Health Urgent Care & Clinic, and we require some additional information before we can complete the credentialing process. Please provide or clarify the following items:  • The liability insurance that was provided with the application is for an individual provider. Please provide a copy of the liability insurance for the facility.  If you have any questions regarding the requested information above, please contact Cody Dodgen at: cododgen@wellmed.net or (210) 951-3092. I appreciate your assistance.  My Regards, Bianca Cole Sr. Provider Service & Experience Manager WellMed Medical Management, Inc. O +1 (832) 973-8154', NULL, NULL, '2021-07-20 10:44:06', '2021-07-20 10:44:06'),
(36633, 1006, 28464, NULL, '2021-08-02 00:00:00.000', 'In Process', 'Replied with the requested information @ cododgen@wellmed.net & bcole1@wellmed.net:  \"Hello Cody,   Please find the attached COI, it covers both the provider and the facility. Do let me know if this is sufficient.  Thank you. \"', NULL, NULL, '2021-07-26 08:19:52', '2021-07-26 08:19:52'),
(36634, 11056, 28464, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	cododgen@wellmed.net    &   bcole1@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Bianca!  Hope you are doing well. Please accept my apology for the last email. Here is the copy of the liability insurance for the facility you requested for. Kindly see the attachment.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   If you need any additional information or documents please feel free to reach out to me soon. Waiting for your response.  Thank you! Have a Great week ahead!', NULL, NULL, '2021-08-04 08:45:18', '2021-08-04 08:45:18'),
(36635, 11056, 28464, NULL, '2021-08-11 00:00:00.000', 'In Process', 'Email sent to : 	cododgen@wellmed.net    &   bcole1@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Bianca!  Hope you are doing well. Please accept my apology for the last email. Here is the copy of the liability insurance for the facility you requested for. Kindly see the attachment.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice Tax ID# 84-4737737 Practice NPI# : 1013540962 Practice Address: 3003 TEXAS PKWY UNIT B MISSOURI CITY , TX 77489-5242   If you need any additional information or documents please feel free to reach out to me soon. Waiting for your response.  Thank you! Have a Great week ahead!', NULL, NULL, '2021-08-04 08:45:19', '2021-08-04 08:45:19'),
(36636, 11056, 28464, NULL, '2021-08-22 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Morning,     Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-10 14:46:10', '2021-08-10 14:46:10'),
(36637, 11056, 28464, NULL, '2021-08-23 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good morning Michelle!  Hope all is well. I wanted to inquire about the enrollment status of the provider and group. Kindly update me with the enrollment status of the below mentioned provider and group soon.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a nice day!  I have tried to reach out through call but she is working from home. And recorder just allowed me to left out the voice message for her about the issue.', NULL, NULL, '2021-08-16 11:34:23', '2021-08-16 11:34:23'),
(36638, 11056, 28464, NULL, '2021-08-31 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good afternoon. As of 8/16 the group is still in credentialing. Group Tax ID is in process with credentialing. WellMed credentialing commenced 6/8/2021. All updates will be provided when credentialing is completed. Please allow 60-90 days for credentialing. You may be contacted directly by WellMed Contracting and Credentialing for any missing information that may delay the process.     Thank you for your continued patience.     Thank you,  Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-08-23 14:25:15', '2021-08-23 14:25:15'),
(36639, 11056, 28464, NULL, '2021-09-07 00:00:00.000', 'In Process', 'Email sent to : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Hey Michelle!  Hope this email finds you well. You have already informed me about this about 60-90 days for credentialing on 14 of July,2021. Now you are saying the same.  Please provide me with the latest updates soon. And inform me with the exact time frame for the process.  Practice Details: Practice Name: Best Health Urgent Care & Clinic Practice  NPI # : 1013540962 Practice  TIN # : 84-4737737  Providers: Provider Name: Tann, Shametria Provider  NPI # : 1124615612  Provider Name : Cyriaque, Stephane Provider NPI# : 1780192633  If you need any further information please let me know. Waiting to hear from you soon.  Thank you! Have a wonderful week ahead!', NULL, NULL, '2021-08-31 11:03:44', '2021-08-31 11:03:44'),
(36640, 11056, 28464, NULL, '2021-09-15 00:00:00.000', 'In Process', 'Email received from : mbangert@wellmed.net  Sub : Enrollment Request Application - BHUCC - Wellmed  Good Afternoon.     As of 8/25 the group is still in process. WellMed loading and credentialing commenced 6/8/2021and can take 60-90 days for completion. The Best Health UC is not presently loaded in WellMed’s system for UC services under the WellMed agreement as of today.     The completion time may vary based on volume of contracts in the processing queue and may vary if any unforeseen items occur in the credentialing process.     The group is presently in the usual and customary time frame and no further updates will become available until after 9/8/2021. However the group may be contacted directly by WellMed Contracting and Credentialing Department for any missing information that may delay the loading process.     Thank you for your continued patience.     Thank you,     Michelle Bangert, Sr. Contract Consultant Manager  Ph.: 1-813-767-5236| MBangert@WellMed.net', NULL, NULL, '2021-09-08 14:47:05', '2021-09-08 14:47:05'),
(36641, 11056, 28464, NULL, '2021-09-16 00:00:00.000', 'Approved', 'Approval Email received from : mbangert@wellmed.net  Sub  : RE: [EXTERNAL] Re: Enrollment Request Application - BHUCC - WellMed - effective WM PAR 9/1/2021  Good Afternoon,     The Group BHUCC is WellMed PAR and effective for Houston as of 09/01/2021.     A screenshot of the internal WellMed load is provided for your records.    Please see the attachment.', NULL, NULL, '2021-09-09 16:20:03', '2021-09-09 16:20:03'),
(36642, 3040, 28465, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36643, 3040, 28465, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:31', '2021-05-06 16:05:31'),
(36644, 3040, 28465, NULL, '2021-05-13 00:00:00.000', 'Rejected', 'Provider is no longer working with VMUC. ', NULL, NULL, '2021-05-06 16:10:11', '2021-05-06 16:10:11'),
(36645, 3040, 28466, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36646, 3040, 28466, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:36', '2021-05-06 16:05:36'),
(36647, 3040, 28466, NULL, '2021-06-07 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, '2021-05-31 10:13:59', '2021-05-31 10:13:59'),
(36648, 3040, 28467, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36649, 3040, 28467, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:40', '2021-05-06 16:05:40'),
(36650, 3040, 28467, NULL, '2021-06-07 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, '2021-05-31 10:14:11', '2021-05-31 10:14:11'),
(36651, 3040, 28468, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36652, 3040, 28468, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:43', '2021-05-06 16:05:43'),
(36653, 3040, 28468, NULL, '2021-06-07 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, '2021-05-31 10:14:23', '2021-05-31 10:14:23'),
(36654, 3040, 28469, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36655, 3040, 28469, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:47', '2021-05-06 16:05:47'),
(36656, 3040, 28469, NULL, '2021-06-07 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, '2021-05-31 10:14:36', '2021-05-31 10:14:36'),
(36657, 3040, 28470, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36658, 3040, 28470, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:51', '2021-05-06 16:05:51'),
(36659, 3040, 28470, NULL, '2021-06-07 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, '2021-05-31 10:14:40', '2021-05-31 10:14:40'),
(36660, 3040, 28471, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36661, 3040, 28471, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:05:56', '2021-05-06 16:05:56'),
(36662, 3040, 28471, NULL, '2021-06-07 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, '2021-05-31 10:14:53', '2021-05-31 10:14:53'),
(36663, 3040, 28472, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36664, 3040, 28472, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:00', '2021-05-06 16:06:00'),
(36665, 3040, 28472, NULL, '2021-06-07 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, '2021-05-31 10:15:05', '2021-05-31 10:15:05'),
(36666, 3040, 28473, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36667, 3040, 28473, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:03', '2021-05-06 16:06:03'),
(36668, 3040, 28473, NULL, '2021-06-07 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, '2021-05-31 10:15:16', '2021-05-31 10:15:16'),
(36669, 3040, 28474, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36670, 3040, 28474, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:08', '2021-05-06 16:06:08'),
(36671, 3040, 28474, NULL, '2021-06-07 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, '2021-05-31 10:15:26', '2021-05-31 10:15:26'),
(36672, 3040, 28475, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55');
INSERT INTO `cm_credentialing_task_logs` (`id`, `user_id`, `credentialing_task_id`, `last_follow_up`, `next_follow_up`, `status`, `details`, `image`, `pdf`, `created_at`, `updated_at`) VALUES
(36673, 3040, 28475, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:11', '2021-05-06 16:06:11'),
(36674, 3040, 28475, NULL, '2021-06-07 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, '2021-05-31 10:15:35', '2021-05-31 10:15:35'),
(36675, 3040, 28476, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 15:59:55', '2021-05-06 15:59:55'),
(36676, 3040, 28476, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:15', '2021-05-06 16:06:15'),
(36677, 3040, 28476, NULL, '2021-06-07 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, '2021-05-31 10:15:45', '2021-05-31 10:15:45'),
(36678, 3040, 28477, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:01:28', '2021-05-06 16:01:28'),
(36679, 3040, 28477, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:19', '2021-05-06 16:06:19'),
(36680, 3040, 28477, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Hello Anderson,  Thank you so much for your prompt response. Can you please send me the copy of the facility agreement? Also can you please confirm that all the three locations are updated in your system?  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-10 15:26:07', '2021-05-10 15:26:07'),
(36681, 3040, 28477, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email rcvd from: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Good Morning,  Our Expedite team asked me to assist.  You are currently contracted under a facility agreement so we do not add or credential providers under this contract type.  We can assist If you are wanting to add additional locations.  Please advise.  Kindly,  Velann Anderson', NULL, NULL, '2021-05-10 15:27:22', '2021-05-10 15:27:22'),
(36682, 3040, 28477, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Good Morning,  Our Expedite team asked me to assist.  You are currently contracted under a facility agreement so we do not add or credential providers under this contract type.  We can assist If you are wanting to add additional locations.   Please advise.  Kindly,  Velann Anderson Provider Relations Manager, Network Management FirstCare Health Plans—part of Baylor Scott & White Health 806-403-9637 Fax Velann.Anderson@BSWHealth.org', NULL, NULL, '2021-05-31 10:13:07', '2021-05-31 10:13:07'),
(36683, 3040, 28478, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:01:36', '2021-05-06 16:01:36'),
(36684, 3040, 28478, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:06:55', '2021-05-06 16:06:55'),
(36685, 3040, 28478, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Hello Anderson,  Thank you so much for your prompt response. Can you please send me the copy of the facility agreement? Also can you please confirm that all the three locations are updated in your system?  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-10 15:26:20', '2021-05-10 15:26:20'),
(36686, 3040, 28478, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email rcvd from: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Good Morning,  Our Expedite team asked me to assist.  You are currently contracted under a facility agreement so we do not add or credential providers under this contract type.  We can assist If you are wanting to add additional locations.  Please advise.  Kindly,  Velann Anderson', NULL, NULL, '2021-05-10 15:27:27', '2021-05-10 15:27:27'),
(36687, 3040, 28478, NULL, '2021-06-07 00:00:00.000', 'Approved', 'Good Morning,  Our Expedite team asked me to assist.  You are currently contracted under a facility agreement so we do not add or credential providers under this contract type.  We can assist If you are wanting to add additional locations.   Please advise.  Kindly,  Velann Anderson Provider Relations Manager, Network Management FirstCare Health Plans—part of Baylor Scott & White Health 806-403-9637 Fax Velann.Anderson@BSWHealth.org', NULL, NULL, '2021-05-31 10:13:18', '2021-05-31 10:13:18'),
(36688, 3040, 28479, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:01:41', '2021-05-06 16:01:41'),
(36689, 3040, 28479, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:32', '2021-05-06 16:08:32'),
(36690, 3040, 28479, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email sent to: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Hello Anderson,  Thank you so much for your prompt response. Can you please send me the copy of the facility agreement? Also can you please confirm that all the three locations are updated in your system?  Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-10 15:26:32', '2021-05-10 15:26:32'),
(36691, 3040, 28479, NULL, '2021-05-17 00:00:00.000', 'In Process', 'Email rcvd from: Velann.Anderson@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Good Morning,  Our Expedite team asked me to assist.  You are currently contracted under a facility agreement so we do not add or credential providers under this contract type.  We can assist If you are wanting to add additional locations.  Please advise.  Kindly,  Velann Anderson', NULL, NULL, '2021-05-10 15:27:32', '2021-05-10 15:27:32'),
(36692, 3040, 28479, NULL, '2021-05-18 00:00:00.000', 'In Process', ' Form submitted online for additional location.  Thank you again for your interest in becoming a Scott and White Health Plan contracted provider.  Please allow 30-45 days before checking on status.  Your form submission identifier is: 857ed844-51bd-445e-98be-5f510c3505b1', NULL, NULL, '2021-05-11 09:03:09', '2021-05-11 09:03:09'),
(36693, 3040, 28479, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVSERVICES@bswhealth.org  Subject: Re: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,   Hope you are doing well. I wanted to know the status for an additional location in our group Valley Med Urgent Care PLLC. Below are mentioned the additional location details:   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thanks ', NULL, NULL, '2021-05-31 10:24:12', '2021-05-31 10:24:12'),
(36694, 3040, 28479, NULL, '2021-06-24 00:00:00.000', 'In Process', 'Email rcvd from: SWHPPROVSERVICES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Good afternoon,  This demographic update request was submitted on 5/11/2021 and is still in process.  Requests can take approximately 30-45 days to process.  Please allow 30 days before checking the status of any address change request.   Thank you so much,  Lacey b', NULL, NULL, '2021-06-17 12:05:37', '2021-06-17 12:05:37'),
(36695, 3040, 28479, NULL, '2021-07-12 00:00:00.000', 'In Process', 'Email sent to: SWHPPROVSERVICES@bswhealth.org  Subject: Re: Re: Re: Re: Re: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Hello,   Hope you are doing well. I wanted to know the status for an additional location in our group Valley Med Urgent Care PLLC. Below are mentioned the additional location details:   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Additional Location: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248  Please get back to me as soon as you can get a chance. Waiting for your response.    Thank you ', NULL, NULL, '2021-07-05 14:24:56', '2021-07-05 14:24:56'),
(36696, 3040, 28479, NULL, '2021-07-13 00:00:00.000', 'Approved', 'Email rcvd from: SWHPPROVSERVICES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Good evening,  The address change request was completed on 06/03/2021.  Thank you so much,  Lacey B', NULL, NULL, '2021-07-06 08:26:54', '2021-07-06 08:26:54'),
(36697, 3040, 28480, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36698, 3040, 28480, NULL, '2021-05-13 00:00:00.000', 'Rejected', 'Provider is no longer working with VMUC ', NULL, NULL, '2021-05-06 16:07:28', '2021-05-06 16:07:28'),
(36699, 3040, 28481, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36700, 3040, 28481, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:34', '2021-05-06 16:07:34'),
(36701, 3040, 28481, NULL, '2021-06-07 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, '2021-05-31 10:16:26', '2021-05-31 10:16:26'),
(36702, 3040, 28482, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36703, 3040, 28482, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:38', '2021-05-06 16:07:38'),
(36704, 3040, 28482, NULL, '2021-06-07 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, '2021-05-31 10:16:42', '2021-05-31 10:16:42'),
(36705, 3040, 28483, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36706, 3040, 28483, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:42', '2021-05-06 16:07:42'),
(36707, 3040, 28483, NULL, '2021-06-07 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, '2021-05-31 10:16:51', '2021-05-31 10:16:51'),
(36708, 3040, 28484, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36709, 3040, 28484, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:46', '2021-05-06 16:07:46'),
(36710, 3040, 28484, NULL, '2021-06-07 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, '2021-05-31 10:17:00', '2021-05-31 10:17:00'),
(36711, 3040, 28485, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36712, 3040, 28485, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:49', '2021-05-06 16:07:49'),
(36713, 3040, 28485, NULL, '2021-06-07 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, '2021-05-31 10:17:10', '2021-05-31 10:17:10'),
(36714, 3040, 28486, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36715, 3040, 28486, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:53', '2021-05-06 16:07:53'),
(36716, 3040, 28486, NULL, '2021-06-07 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, '2021-05-31 10:17:18', '2021-05-31 10:17:18'),
(36717, 3040, 28487, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36718, 3040, 28487, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:07:57', '2021-05-06 16:07:57'),
(36719, 3040, 28487, NULL, '2021-06-07 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, '2021-05-31 10:17:28', '2021-05-31 10:17:28'),
(36720, 3040, 28488, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36721, 3040, 28488, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:01', '2021-05-06 16:08:01'),
(36722, 3040, 28488, NULL, '2021-06-07 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, '2021-05-31 10:17:41', '2021-05-31 10:17:41'),
(36723, 3040, 28489, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36724, 3040, 28489, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:04', '2021-05-06 16:08:04'),
(36725, 3040, 28489, NULL, '2021-06-07 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, '2021-05-31 10:17:53', '2021-05-31 10:17:53'),
(36726, 3040, 28490, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36727, 3040, 28490, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:08', '2021-05-06 16:08:08'),
(36728, 3040, 28490, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual providers. For more details please see group task. ', NULL, NULL, '2021-05-31 10:18:04', '2021-05-31 10:18:04'),
(36729, 3040, 28490, NULL, '2021-06-24 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, '2021-06-17 12:03:06', '2021-06-17 12:03:06'),
(36730, 3040, 28491, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:38', '2021-05-06 16:03:38'),
(36731, 3040, 28491, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:13', '2021-05-06 16:08:13'),
(36732, 3040, 28491, NULL, '2021-06-07 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, '2021-05-31 10:18:14', '2021-05-31 10:18:14'),
(36733, 3040, 28492, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:45', '2021-05-06 16:03:45'),
(36734, 3040, 28492, NULL, '2021-05-13 00:00:00.000', 'Rejected', 'Provider is no longer with VMUC. ', NULL, NULL, '2021-05-06 16:08:50', '2021-05-06 16:08:50'),
(36735, 3040, 28493, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:45', '2021-05-06 16:03:45'),
(36736, 3040, 28493, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:08:57', '2021-05-06 16:08:57'),
(36737, 3040, 28493, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-05-31 10:26:43', '2021-05-31 10:26:43'),
(36738, 3040, 28493, NULL, '2021-06-24 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-06-17 12:05:54', '2021-06-17 12:05:54'),
(36739, 3040, 28493, NULL, '2021-07-13 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, '2021-07-06 08:27:52', '2021-07-06 08:27:52'),
(36740, 3040, 28494, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:45', '2021-05-06 16:03:45'),
(36741, 3040, 28494, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:09:01', '2021-05-06 16:09:01'),
(36742, 3040, 28494, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-05-31 10:26:48', '2021-05-31 10:26:48'),
(36743, 3040, 28494, NULL, '2021-06-24 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-06-17 12:05:59', '2021-06-17 12:05:59'),
(36744, 3040, 28494, NULL, '2021-07-13 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, '2021-07-06 08:27:57', '2021-07-06 08:27:57'),
(36745, 3040, 28495, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:45', '2021-05-06 16:03:45'),
(36746, 3040, 28495, NULL, '2021-05-13 00:00:00.000', 'In Process', 'Email sent to: SWHPEXPEDITES@bswhealth.org  Subject: Group & Providers || Valley Med Urgent Care PLLC || Group & Providers || Scott & White ||  Greetings,  Hope you are doing well. I wanted to enroll the below mentioned group and providers in Scott & White for our group Valley Med Urgent Care PLLC under all three locations.   Practice Details: Practice Name: Valley Med Urgent Care PLLC (All three locations) Practice Tax-ID# 81-5123542 Practice NPI# 1518404631 Primary Address: 2534 Boca Chica Blvd Brownsville , TX 78521-3496 Secondary Address: 800 E Alton Gloor Blvd Brownsville , TX 78526-4248 Tertiary Address: 101 E. Expressway 83, Suite #170 McAllen , TX 78501-1166  Provider 1: Provider Name: Escobar, Angiollet Solis Provider NPI# 1962917997  Provider 2: Provider Name: Rodriguez, Cynthia Provider NPI# 1124282553  Provider 3: Provider Name: Naranjo, Diego Provider NPI# 1568929800  Provider 4: Provider Name: Garcia, Homero Provider NPI# 1730564857  Provider 5: Provider Name: Lira, Arturo Alejandro Provider NPI# 1245789502  Provider 6: Provider Name: Lopez, Mayra Alejandra Provider NPI# 1265945125  Provider 7: Provider Name: Potter, Deborah Provider NPI# 1861914053  Provider 8: Provider Name: Saavedra, Teresa Provider NPI# 1255676151  Provider 9: Provider Name: Wright, Larry Donald Provider NPI# 1033769765  Provider 10: Provider Name: Wert, Jeniece K Provider NPI# 1659919702  Provider 11: Provider Name: Hernandez, Eder Francisco Provider NPI# 1386956852  If you need any additional information please feel free to call or email me. Waiting to hear from you soon.   Thank you ', NULL, NULL, '2021-05-06 16:09:05', '2021-05-06 16:09:05'),
(36747, 3040, 28495, NULL, '2021-06-07 00:00:00.000', 'In Process', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-05-31 10:26:51', '2021-05-31 10:26:51'),
(36748, 3040, 28495, NULL, '2021-06-24 00:00:00.000', 'On Hold', 'Group has an ancillary contract. No need to add individual provides. Location addition request was sent out its still in process. Once location added under the group we will approved the providers task. For details please see group task.  ', NULL, NULL, '2021-06-17 12:06:09', '2021-06-17 12:06:09'),
(36749, 3040, 28495, NULL, '2021-07-13 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, '2021-07-06 08:28:02', '2021-07-06 08:28:02'),
(36750, 3040, 28496, NULL, NULL, 'New/Not Initiated', '', NULL, NULL, '2021-05-06 16:03:45', '2021-05-06 16:03:45');
