Contracting With Peoples Health

Providers interested in contracting with Peoples Health should complete a provider application.

Current Peoples Health network providers should email contracting questions or requests to ndaapplication@peopleshealth.com. We will direct your inquiry to the appropriate representative, who will contact you regarding your request. You can also contact your provider representative for assistance.

Provider Application for Contracting with Peoples Health

Fields marked with an asterisk (*) are required.

1Please enter your information below.

2Please confirm your information is correct and click submit.

To submit a request to join the Peoples Health provider network, please complete the online application below. Contracting is limited to our service area. Peoples Health plans serve all Louisiana parishes. The application may take 15-30 minutes to complete. Please have all required information available before proceeding, as incomplete applications cannot be processed.

You must complete all required fields and attach a curriculum vitae for each provider at your practice or facility who is interested in contracting with Peoples Health. Required fields are noted with an asterisk. Please have available your Medicare/PTAN and TIN numbers, as well as your Medicaid and CAQH numbers if applicable. If you have applied for a Medicare number and haven’t yet received it, please contact Medicare for a status update. Do not submit an application until the number has been issued. Include the following in the Additional Information and Comments section:
- Areas serviced, including any special services offered
- Any area hospitals with which you have an association (list hospital and status, for example, active, courtesy, temp, etc.)
- Mailing address if different from service address
Provider Type*
Contact Name*
First Last
Physician Name*
First Last
Physician Type*
- Primary Care Physician
- Specialist
- Multi-specialist
Physician Type - Other
Physician Degree*
- MD
- DD
- DMD
- DPM
- DC
- DO
Physician Degree - Other
Hospital Name*
Ancillary Facility Name*
Legal Entity/DBA*
Legal Entity*
Practice Name*
DBA/Practice Name*
Office or Facility Address*
Street Address Address Line 2 City State ZIP Code
Primary Office Address (include building or suite number)*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax*
Email*
Hours of Operation*
Specialty 1
Specialty 2
Services Provided*
Additional information and comments
Please include areas serviced; any special services offered; any area hospitals with which you have an association, list hospital and status, for example, active, courtesy, temp, etc.; and your mailing address if different from your service address
Board Certified*
- Yes
- No
Primary Certification
Secondary Certification

List all practicing physicians at this location (you may include up to 10), or attach a physician roster.*

Physician First Name *	Physician Last Name *	Specialty *	NPI *	TIN *	Medicare /PTAN*	Medicaid	CAQH

Additional Locations (include building or suite number)
Location 1
Street Address Address Line 2 City State ZIP Code
Location 2
Street Address Address Line 2 City State ZIP Code
Location 3
Street Address Address Line 2 City State ZIP Code

Provide the required information in this section for each location listed above. You may include up to 3 additional locations on this application.*

NPI *	TIN *	Medicare /PTAN*	Medicaid	CAQH

Languages (other than English) spoken at primary location
Additional information and comments
Please include areas serviced; any special services offered; any area hospitals with which you have an association, list hospital and status, for example, active, courtesy, temp, etc.; and your mailing address if different from your service address
Please attach a curriculum vitae for each physician at your practice or facility.
Drop files here or

Accepted file types: pdf, jpg, tif, gif, doc, docx, xls, xlsx, Max. file size: 64 MB, Max. files: 7.
Please attach a curriculum vitae.
Drop files here or

Accepted file types: pdf, jpg, tif, gif, doc, docx, xls, xlsx, Max. file size: 64 MB, Max. files: 7.

Contracting With Peoples Health

Contracting With Peoples Health

Additional Locations (include building or suite number)