Martin's Point Health Care
:
New Provider Request
Add a Provider (or Specialty) at a Location
= Required Information
Provider Information
Employee Status
Permanent:
Full-time PCP or Specialist joining your practice (or adding a specialty)
Temporary:
Per Diem or Locum Tenens (includes covering providers)
Please wait...
*
Provider NPI
*
Provider First Name
Provider Middle Name
*
Provider Last Name
Provider Suffix
--None--
Jr
Sr
II
III
IV
*
Provider Degree
--None--
ANP
AuD
CNM
CNS
DC
DO
DPM
FNP
MD
OD
PA
PNP
Specialty 1
Select a provider type to view the specialties that require credentialing in order to be shown in our provider directory. If the specialty is not listed below, credentialing is not required and advance information about the provider is not needed.
Please note that contracted providers who are not credentialed will be added to our system based on information submitted with claims.
Provider Type
Primary Care Provider:
Provides primary care for a panel of patients.
Specialist:
Provides specialty care and accepts referrals, including CNM.
Please wait...
Specialty 2 (if applicable)
Provider Type
Primary Care Provider:
Provides primary care for a panel of patients.
Specialist:
Provides specialty care and accepts referrals, including CNM.
Please wait...