Become a Provider

Are You Currently a Contracted Provider?

Contracted Providers

To add your facilities including Ancillary, Behavioral Health, and Hospital providers to your existing participating contract:

To add practitioners to your current contract:

To Become a Provider

Thank you for your interest in joining Community Care Plan's Provider Network. Community Care Plan (CCP) is an entity owned and operated by South Florida's most experienced names in healthcare: Broward Health / North Broward Hospital District and Memorial Healthcare System / South Broward Hospital District in Broward County.

To start the credentialing process, please complete the Letter of Interest (LOI) form below and follow the submission instructions. Once this information is received, you will be notified by CCP of the next steps in the credentialing process. Credentialing connects you with a growing network of professionals across Florida, whose qualifications are carefully vetted and approved to distinguish the network as one that is committed to quality across all standards of care.

Contracting Contact Name:*
Contracting Contact Email:* 
Contracting Contact Phone:* 
Credentialing Contact Name:*
Credentialing Contact Email:* 
Credentialing Contact Phone:* 
Group Name (as it appears on W-9)* 
Doing Business As (DBA) Name:*
Corporation Type:* 

Tax ID:* 
Billing/Group NPI:*
Scope of Services:* 
Group Medicaid ID: 
Age Range:* 
Primary / Corporate Address:* 
 Zip Code:* 
Practice Website:
EMR Name: 
After hours coverage:
Telemedicine Services:
Board Certified:
Patient Centered Medical Home (PCMH):
PCMH Accreditation/Recognition Program:
NCQA Behavioral Health (BH) Integration Distinction:
NCQA Patient Centered Specialty Practice:
Interested in delegated credentialing?:

Service Area (check all that apply):*

Lines of business you are interested in (check all that apply):*



Are you Human:

Enter security code:
 Security code


Please be assured that our staff is here to assist you in the process and answer any questions you may have. Should you have any questions or concerns, please call 1-855-819-9506 or email

Thank you again for your interest.