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Provider Enrollment > Practitioner Groups

Provider Enrollment



Option 1

Multi Professional Group Providers ...

Group is comprised of various Licensed Professionals, e.g., physicians, nurse practitioners, registered physician assistants, clinical psychologists, podiatrists, chiropractors, clinical social workers, optometrists, therapists (physical, occupational, speech)

Click here for the Enrollment Form and Instructions.

Option 2

Group is comprised of Physicians Only, OR Physicians and/or Nurse Practitioners and/or Physician Assistants ...


Click here for the Enrollment Form and Instructions.

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