Join our Provider Network

Thank you for your interest in becoming a participating provider with Independent Health. Please complete the following steps to begin the credentialing process.

Step 1
Register/Update with The Council for Affordable Quality Healthcare (CAQH)
Register or update with CAQH here
(You will have to list Independent Health as an authorized viewer online with CAQH).
If you do not have your CAQH ID, call CAQH at 1-888-599-1771.
Once you have completed your registration and have listed Independent Health as an authorized viewer, please proceed to step 2.

Step 2
Review, complete and email back the Provider Enrollment Form which can be accessed from the link below.

Independent Health credentials the Health Care Professionals listed below:Physicians (MD,DO), Nurse Practitioners (NP), Physician Assistants (PA), Licensed Nurse Midwives (LNM), Certified Registered Nurse Anesthetists (CRNA), Independent Nurse Practitioners (INP), Licensed Certified Social Workers (LCSW-R), Physical Therapists (PT), Occupational Therapists (OT), Speech Language Pathologists (SLP), Registered Dietitians (RD) Optometrists (OD), Psychologists (PhD), Audiologists ( AUD), Licensed Dentists( DDS), Chiropractors( DC), Podiatrists( DPM)

  • Please email your completed form to
  • Incomplete applications will delay the processing time.
  • Please note that you may not provide services to Independent Health members until you are approved for participation.

2017 Provider Enrollment Form