Join our network by completing this form.
If your practice is already contracted with Gateway Health but need to make a change, like one of the changes listed below, please complete the Practice Change form.
• Address Changes;
• Phone & Fax number changes;
• Changes of hours of operation;
• Primary Care Practice (PCP) panel status changes (Open, Closed & Existing Only);
• Practitioner participation status (additions & terminations) and;
• Mergers and acquisitions.
If your practice is already contracted with Gateway Health but need to add a new physician please complete the Provider Data Form to initiate Credentialing.
If you are a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) please complete a roster whenever you have New Adds, Demographic changes and Terminations occur within your FQHC/RHC practice location(s). Roster template
Please email the completed roster to: [email protected].