ENROLLMENT FORM

Category(s) of Service: 0464

If you are ALREADY ENROLLED and need to change your address, click here.

  Application Fee is NOT Required  


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Provider Index > DOULA (Pilot Program)

Provider Enrollment & Maintenance



Instructions for doulas enrolling as a provider in the New York State (NYS) Medicaid Doula Pilot Program:
  • Only doulas serving NYS Medicaid eligible clients residing in Erie County and all zip codes in Kings County except 11207, 11208, 11212, 11216, 11221, 11233 will be able to apply for enrollment in the NYS Medicaid Doula Pilot Program.
  • Once enrolled as a NYS Medicaid provider, doulas will be able to bill NYS Medicaid for up to three prenatal visits, support during labor and delivery, and up to four postpartum visits provided to Medicaid eligible clients residing in the above-mentioned areas.
  • To become a doula provider for NYS Medicaid Managed Care clients, a doula must first enroll with the NYS Medicaid Program.
  • Once enrolled as a NYS Medicaid provider, a doula can then reach out to the MCOs that are participating in the Doula Pilot Program to apply to join the MCOs' doula provider network.

For more information about the NYS Doula Pilot Program please visit: https://www.health.ny.gov/health_care/medicaid/redesign/doulapilot/


Complete this Enrollment Form if you are:
  1. Applying for initial ENROLLMENT or ALREADY ENROLLED and enrolling another NPI, or
  2. Responding to a letter instructing you to REVALIDATE your enrollment, or
  3. Seeking REINSTATEMENT or REACTIVATION of your previous enrollment

PRACTITIONER Enrollment Form

Last Updated: 11/2018


Supplemental Information

If you have any questions or concerns, please contact the eMedNY Call Center at 1-800-343-9000 or click here to send us an email.


NOTE: This is just a Test Development Site.

This DOES NOT reflect the production website at emedny.org.