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First Name
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Practice/Group Name
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Email Address
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Address
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National Provider Identifier (NPI)
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Service Delivery Area (SDA)
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Products
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CHIP/CHIP Perinate
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STAR Health
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STAR+PLUS Medicare-Medicaid Plan (MMP)
Specialty Type
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Adult Day Care or Assisted Living
Neurology
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Ambulatory
OB/GYN
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Orthopedics
Audiology
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Behavioral Health or Counselor
Oncology
Cardiology
Therapy (Physical/Occupational/Speech)
Critical Care or Emergency Medicine
Pathology
Dental
Pharmacy
Dermatology
Pediatrics
Durable Medical Equipment (DME)
Podiatry
Ear, Nose and Throat (ENT)
Primary Care Provider (PCP)
Endocrinology
Pulmonology
Federally Qualified Health Center (FQHC)
Radiology
Gastroenterology
Rheumatology
Home Health
Rural Health Clinic
Hospital
Skilled Nursing Facility
Interventional Pain Management
Urgent Care
Long-Term Services and Supports (LTSS)
Urology
Nephrology
Other