1 Start 2 Complete If you know of a medical or dental practitioner or a facility that is not a member of the HealthChoice Provider Network, and you would like them to join, you can nominate them for participation. Leave us some basic information and we will contact the provider, on your behalf, and ask them to consider contracting with HealthChoice to become a network provider. The contracting process may take several weeks or longer. The provider must satisfy our business requirements and meet our contracting standards. Your nomination does not guarantee the provider is eligible for participation in the network or will agree to contract with us. Please provide the following information so we can contact your provider: Enter provider name * Select specialty - None -Addiction MedicineAllergy/ImmunologyAmbulance Service SupplierAmbulatory Surgery CenterAnesthesiologist AssistantAnesthesiologyAudiologistBariatric Surgery Centers of ExcellenceBoard Certified Behavioral AnalystBoard Certified Assistant Behavioral AnalystCardiac SurgeryCardiologyCardiothoracic SurgeryCertified Registered Nurse AnesthetistCertified Clinical Nurse SpecialistCertified Nurse MidwifeCertified Nurse PractitionerChiropracticChristian Science NurseChristian Science PractitionerClinical LaboratoryClinical PsychologistColorectal SurgeryCounselorCritical CareDentistryDermatologyDiagnostic RadiologyDialysis FacilityEmergency MedicineEndocrinologyEndodonticsGastroenterologyGeneral PracticeGeneral SurgeryGeneticsGeriatric MedicineGynecological/OncologyHand SurgeryHematologyHome Health AgencyHospiceHospitalIndependent Diagnostic Testing FacilityIndian Health FacilityIndian Health ProfessionalIndividual Certified OrthotistIndividual Certified ProsthetistInfectious DiseaseInfertilityInfusion TherapyInternal MedicineLicensed Clinical Social WorkerLong Term Care HospitalMaxillofacial SurgeryMedical OncologyMedical Supply CompanyMental Health/Substance Abuse FacilityMilitary FacilityNeonatologyNephrologyNeurologyNeuropsychiatryNeurosurgeryNuclear MedicineObstetrics/GynecologyOccupational MedicineOccupational TherapistOcularistOphthalmologyOptometryOral SurgeryOrthodonticsOrthopedic SurgeryOtolaryngologyPain ManagementPathologyPediatric DentistryPediatric MedicinePerfusionistPeriodonticsPharmacistPhysical Medicine and RehabilitationPhysical TherapistPhysician AssistantPlastic and Reconstructive SurgeryPodiatryPreventive MedicineProsthodonticsPsychiatryPulmonary DiseaseRadiation OncologyRadiation Therapy CentersRegistered Dietitian/Nutrition ProfessionalRehabilitation FacilityRheumatologyRural Health ClinicSkilled Nursing FacilitySleep MedicineSleep StudySpeech PathologySports MedicineThoracic SurgeryUrologyVA HospitalVascular Surgery Enter provider phone number * Enter provider email address Enter provider address * Country * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Address 1 * Address 2 City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming--Armed Forces (Americas)Armed Forces (Europe, Canada, Middle East, Africa)Armed Forces (Pacific)American SamoaFederated States of MicronesiaGuamMarshall IslandsNorthern Mariana IslandsPalauPuerto RicoVirgin Islands ZIP code * I am a: * Member Provider Insurance/Benefits Coordinator Other If a facility is a member of the HealthChoice Provider Network, they can also be nominated for the HealthChoice Select program. Only facilities can participate in HealthChoice Select, not individual practitioners. Would you like to nominate this facility for HealthChoice Select? Yes No Is this facility currently a member of HealthChoice Provider Network? Yes No Select service type - None -Ankle/FootArthroscopyAnesthesiaBreastCardioChestColonoscopy/SigmoidoscopyCTDigestive SystemElbowEarEyeFracturesGynecologyHernia-Includes MeshHead/FaceHip/PelvisKneeJoint InjectionsJointMaternityMRINeckNoseOral MaxillofacialOpen Reduction Internal FixationOrthopedicPainPETRadiology/RadiographyScopeShoulderSpineSurgeryThroatUrologyUltrasoundVeinWrist/HandInjectionDental If you would like us to follow up with you on the outcome of your nomination, please enter your contact information below. Enter your first name Enter your last name Enter your email Enter your phone number Leave this field blank Submit