This application is for new individual practitioners not currently participating in the CDPHP® network. Individual practitioners who are already credentialed/participating with CDPHP and are requesting an address/tax ID change or other demographic update should complete the Practitioner Information Change Request Form.
IMPORTANT: The New York State Department of Health requires practitioners – with a few exceptions* – to have a NY Medicaid Management Information System (MMIS) ID number prior to enrollment with CDPHP Medicaid, HARP, or Child Health Plus (CHP).
To apply for a NY MMIS ID, visit https://www.emedny.org/info/ProviderEnrollment/index.aspx.
For questions regarding MMIS, contact Provider Services at (518) 641-3500.
*Exceptions include: Acupuncturist (LAc), Licensed Marriage and Family Counselor (LMFT), Licensed Mental Health Counselor (LMHC), Nutritionist/Registered Dietician (RD/RDN), and Orthoptist.
To contract with CDPHP as a facility or ancillary provider offering laboratory, durable medical equipment (DME), home health care, home infusion, transportation, imaging, dialysis, hospice, or skilled nursing services, please contact Healthcare Network Strategy at (518) 641-4290.
If you have any other questions while completing this application, please contact the CDPHP Credentialing Department at (518) 641-3321 or CDPHP_Cred_Dept@cdphp.com for assistance.