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African-American Physicians Additions Form

 

Type of Practice:
Name of Practice or Medical Group:
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First Name:
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Specialty

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Specialty Not Listed:
Hospital Affiliation:
Hospital Not Listed:

Address 1:
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City:
State:
 California
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E-mail:
Web Addresss:
Other Information

Please check all health plans that your office accepts:

Aetna Affiliated Health Network
All Dental PPO's All Dental PPO's
All Dental PPO's All other private plans
all PPO's American Specialty Health Plan
AMERIGROUP AMERIGROUP
Anthem Blue Cross Blue Shield autoquote insurance
autoquote insurance Beech Street; Great West
Blue Cross of California Blue Shield of California
Cal Farm Care 1st Health Plan
Caremore Cash, check, credit card. Will provide receipt f
Cash, check, credit card. Will provide receipt f Cash, check, credit card. Will provide receipt f
Cash, check, credit card. Will provide receipt f Cash, check, credit card. Will provide receipt f
CCN Cigna
Community care network Community Health Plan
Credit Cards Credit Cards
Credit Cards Delta Dental
Delta Dental delta dental
Delta Dental PPO Delta Dental PPO
Delta Dental PPO Denticare
Family P Family PACT
Family PACT Firemans Fund
First Halth/CCN; PHCS GLOBAL CARE
Guardian HbmuGECo
Health Net hill phycican
hill phycican hill phycican
Humana PPO Inland Empire Health Plans
Insurance accepted on Acupuncture and Chiropratic Insurance accepted on Acupuncture and Chiropratic
Insurance accepted on Acupuncture and Chiropratic Inter Valley Health
Kaiser Permanente Managed Health Network
Maxicare Medi-Cal
MEDICARE Medicare
Met Life mobile home insurance
mobile home insurance Most insurances accepted
Most insurances accepted Most insurances accepted
most PPO's including Motion Picture, SAG Motarola Advantage
Motion Picture Motion Picture
Motion Picture Motion Picture
National Health Plans None
One Health Plan of CA Pacificare
pacificare please call to verify--PPO only
Prospect Health Source SAG
SAG, Motion Picture SCAN/Smart Care Health Plans
Secure Horizons Special Credit Programs
Special Credit Programs Special Credit Programs
State Compensation Insurance Fund The Holman Group
Tower Health TRICARE
Tricare UHP Healthcare
Unicare United Healthcare
Universal Care UPMC
US Healthcare/Prudential Ventura County Healthcare
VISION SERVICE PLAN (VSP) Western Dental

Other Health Plan:
Other Health Plan:

Are you accepting new patients? Yes No

 

 

 

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