Provider
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Provider Contract

Provider Contracting Inquiry

If you are a healthcare provider interested in contracting with HealthPartners, please complete the form below and click "Continue".

Please provide your facility or provider name, including DBA (as it appears on w-9).
 
Facility or Provider Name
Doing Business As
Tax Id Number
Address 1
Address 2
City  
State
Zip code
Your Name (first & last)
Phone number - -  Ext 
Fax number - -
Email address
Select Type of Care
If other, please specify
Specialty Type (if applicable)
Able to submit claims electronically
Geographic Area Served
Language, Ethnic and Cultural
 
Identifier
Please provide your unique identifier.
Organizational NPI is preferred and will be required for most types of providers. If you do not qualify for an NPI, please select another identifier.

Accreditations
Please complete all facility accreditations that apply:

AccreditationEffective DateEnd Date
Medical Practitioners
Please add practitioners:
  • If your practice has 7 or less practitioners, complete the information below.
  • If your practice has 7 or more practitioners, Contracting will contact you.
  • If your practice has 0 practitioners, this section will not be completed.
Suffix First Name Last Name DOB Specialty NPI
 
Submit your letter of interest below. Please indicate the services you offer including the geographic area you serve with any other comments/questions