Join Our Provider Network

It’s simple to get started

Licensed and adjunct practitioners who would like to join our provider network can download the applications forms in PDF format and send them to us.

Everything you need can be found on our Provider Forms page.

First Step

Before you do anything else you will need to get an online credentialing application from The Council for Affordable Quality Healthcare (CAQH). This is the required format for all initial CDPHP credentialing and recredentialing.

CAQH Universal Credentialing Datasource 

Licensed Practitioners

Licensed practitioners include physicians, nurse practitioners, physician assistants, certified nurse midwives, chiropractors, dentists, and podiatrists. You will need the following forms:

• Practitioner CAQH Credentialing Application Instructions
• Practitioner Data Collection Form
• Qualification Requirements for Physicians
• Qualification Requirements for Mid-Levels
• Qualification Requirements for Chiropractors, Dentists, and Podiatrists
• Statement of Practitioner's Rights
• Access Standards for Primary Care Physicians and OB/GYNs
• Remittance Agent Designation
• Form W-9: Request for Taxpayer Identification Number and Certification

Adjunct Practitioners

Adjunct practitioners include audiologists, certified orthoptists, certified diabetes educators, non-physician nutritionists, optometrists, occupational therapists, physical therapists, and speech therapists. You will need the following forms:

• Adjunct Practitioner CAQH Credentialing Application Instructions
• Practitioner Data Collection Form
• Qualification Requirements for Adjunct Practitioners
• Statement of Practitioner's Rights
• Remittance Agent Designation
• Form W-9: request for Taxpayer Identification Number and Certification