Vin yon Founisè

Mèsi pou enterè w genyen nan rantre nan Rezo Founisè Community Care Plan. Community Care Plan (CCP) se yon antite ki posede ak opere pa non Sid Florid ki gen plis eksperyans nan swen sante: Broward Health / North Broward Hospital District ak Memorial Healthcare System / South Broward Hospital District 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 epi apwouve yo pou yo fè distenksyon ant rezo a kòm youn ki angaje nan bon jan kalite atravè tout estanda swen.

 
Contact Name:*
 Email:* 
Phone:* 
Group Name (as it appears on W-9)* 
 Tax ID:*
Billing/Group NPI:* 
 Specialty:* 
Group Medicaid ID: 
Age Range:* 
Primary / Corporate Address: 
City: 
State: 
 Zip Code: 
 
 
Practice Website:
After hours coverage:
Telemedicine Services:
Patient Centered Medical Home (PCMH):
PCMH Accreditation/Recognition Program:
NCQA Behavioral Health (BH) Integration Distinction:
NCQA Patient Centered Specialty Practice:
Service Area (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.