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Thank you for your interest in joining Community Care Plan's Provider Network. Community Care Plan (CCP) is an entity owned and operated by South Florida's most experienced names in healthcare: Broward Health / North Broward Hospital District and Memorial Healthcare System / South Broward Hospital District in Broward County.

To start the credentialing process, please complete the Letter of Interest (LOI) form below and follow the submission instructions. Once this information is received, you will be notified by CCP of the next steps in the credentialing process. Credentialing connects you with a growing network of professionals across Florida, whose qualifications are carefully vetted and approved to distinguish the network as one that is committed to quality across all standards of care.

Contact Name:*
Group Name (as it appears on W-9)* 
 Tax ID:*
Billing/Group NPI:* 
Group Medicaid ID: 
Age Range:* 
Primary / Corporate Address: 
 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):

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



Are you Human:

Enter security code:
 Security code


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