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Mèsi pou enterè w genyen nan rantre nan Community Care Plan's Provider Network. Community Care Plan (CCP) se yon antite ki posede ak opere pa non Sid Florid ki gen plis eksperyans nan swen sante:Broward Health / Distri Lopital North Broward ak Memorial Healthcare System / Distri Lopital South Broward nan Broward County.

Pou kòmanse pwosesis kalifikasyon an, tanpri ranpli fòm Lèt Enterè (LOI) ki anba a epi swiv enstriksyon yo soumèt. Yon fwa yo resevwa enfòmasyon sa yo, CCP pral fè w konnen pwochen etap yo nan pwosesis kalifikasyon an. Credentialing konekte ou ak yon rezo pwofesyonèl k ap grandi atravè Florid, ki gen kalifikasyon yo ak anpil atansyon verifye ak apwouve pou fè distenksyon ant rezo a kòm youn ki angaje nan bon jan kalite atravè tout estanda swen..

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:*
Specialty:* 
Scope of Services:* 
Group Medicaid ID: 
Age Range:* 
Primary / Corporate Address:* 
City:* 
State:* 
 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?:
 

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

 

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Tanpri asire w ke anplwaye nou yo la pou ede w nan pwosesis la epi reponn nenpòt kesyon ou ka genyen. Si w gen nenpòt kesyon oswa enkyetid, tanpri rele 1-855-819-9506 oswa voye yon imèl CCP.Provider@ccpcares.org.

Mèsi ankò pou enterè ou.