Provider Directories
Join our Networks

* - required field
How will you be applying to join?:
As an individual practitioner
To add an individual to an existing group, click here to apply via our provider portal.
As an acute care facility such as a hospital
As an ancillary facility such as a lab, rehab or hospice
As a group of 25 or more practitioners, such as an IPA or PHO
As a group of less than 25 practitioners
 
Provider Information:
Please note that including your middle initial will help us find your information faster.
 
Provider's First Name*: Provider's Middle Initial:
Provider's Last Name*: Provider's Suffix:
Group / Facility / Practice Name:
Provider's Gender*: Male Female
Provider's Email: ?
Provider's Phone*: Ext:
NPI #: ?
CAQH ID #: ? If you wish to obtain a CAQH ID, click here.
TIN:
Primary Service Address:
Firm Name: ? Attention: ?
Address Line 1*:
Address Line 2:
City*: State*:   Zip Code*:
Do you have a separate mailing address? Yes No / Don't know
 
Questionnaire:
Are you a hospital based provider?*
What is your primary specialty?*
What is your highest degree?*
Number of doctors in group*:
Do you, or someone on your behalf, have admitting privileges to a hospital that participates in any of the MultiPlan networks (PHCS Network, MultiPlan Network or PHCS Savility)?*
Is there a participating hospital within 25 miles of your primary practice location?* Search
Do you accept direct referrals for patients?*
Do you practice in more than one state?*

Additional Information:
Is there someone we can contact regarding this referral?
Name:
Phone: Ext:
Contact Person, Best Time to Call or Additional Comments
Verification:
Enter text that you see in the image:* (not case sensitive)