Request Web Account
CapConnect Registration Instructions
Please provide the following information to assist us in validating your identity
and establishing your user account (all fields are required).
First Name:
*
Last Name:
*
Primary Office
Address:
*
Company Name:
*
Contact Phone:
*
Email Address:
*
State Lic. Number:
*
IPA / Hospital / Health Plan
Affiliation(s):
Select...
ALAMEDA HEALTH SYSTEM (ALAMEDA)
ALLIANCE HEALTH SYSTEMS (AHS)
ALLSFH (ALLSFH)
AVALON IPA (AVALON)
CANOPY HEALTH (CANOPY)
CENTRAL VALLEY HEALTH PLAN- SANTE PHYSICIANS (SANCVHP)
CENTRAL VALLEY MEDICAL PROVIDERS (SAMG)
CHINO VALLEY MEDICAL CENTER (MFMGCV)
COMMUNITY FAMILY CARE (CFCVP)
DOCTORS HOSPITAL OF MANTECA - HILL PHYSICIANS (HILLMAN)
DOCTORS HOSPITAL OF MANTECA - SUTTER (SGMFMAN)
Doctors Hospital of Modesto (CVMGMOD)
DOCTORS MEDICAL CENTER MODESTO - ALLCARE IPA (ALLMOD)
EXCEPTIONAL CARE - GREATER LOS ANGELES HEALTH CAR (GLAH)
EXCEPTIONAL CARE - GREATER SAN GABRIEL VALLEY PHY (GSGVP)
EXCEPTIONAL CARE - HUNTINGTON PARK (HPMMG)
EXCEPTIONAL CARE -PASADENA PRIMARY CARE PHYSICIA (PPCP)
Exceptional Care –Serendib Healthways (SHI)
FAMILY CHOICE HEALTH SERVICES (FMLYCH)
FAMILY HEALTH ALLIANCE (FAMILY)
FOUNTAIN VALLEY HOSPITAL - AMVI (APFV)
Fountain Valley Hospital – Orange County IPA (OCFV)
FOUNTAIN VALLEY HOSPITAL-OC ADVANTAGE IPA (OCAFV)
HCLASFH (HCLASFH)
Hill Physician Care Solutions Inc (HPCS)
Impact California IPA – Los Angeles (IMPACTLA)
LOS ALAMITOS HOSPITAL - LEISURE WORLD (LWDLOM)
MABUHAY MEDICAL GROUP (MABUHAY)
MDX HAWAII PHYSICIAN NETWORK (MDXHPN)
MIDCITIES MEDICAL GROUP (MIDCITY)
OMNICARE MEDICAL GROUP (OMNI)
PALOMAR HEALTH - Greater Tri Cities IPA (GTCPPH)
PALOMAR POMERADO HEALTH - ARCH HEALTH PARTNER (ARCPPH)
PALOMAR POMERADO HEALTH - GRAYBILL MEDICAL GRO (GMGPPH)
PALOMAR POMERADO HEALTH - SCMG NORTH INLAND (SCMPPH)
PCPIPA (PCPIPA)
PHS Premier Health Services IPA Network (also known as Lakewood IPA, Alamitos IPA, Brookshire IPA, St. Mary IPA, and Fountain Valley IPA) (PREMIER)
PREMIER CARE OF NORTHERN CALIFORNIA (PCNC)
SAINT VINCENT HOSPITAL - ST VINCENT IPA (SVH)
San Benito Medical Associates (SBMA)
SEQUOIA (IMPACTSQ)
Serendib Healthways (SHIDIR)
SOUTHLAND SAN GABRIEL VALLEY MEDICAL GROUP (SSGIPA)
St Francis Medical Center – Angeles IPA (ANGSFH)
UNITED CARE MEDICAL GROUP - COMMERCIAL/SENIOR (UCMGCS)
VALLEY PRESBYTERIAN HOSPITAL - HEALTHCARE L.A. (HCLAVP)
VALLEY PRESBYTERIAN HOSPITAL - PREFERRED IPA (PVP)
*
Required
Provider Tax ID:
*
Provider Name(s):
Provider Name
Include
No providers available for the taxId entered and affiliated IPA / Hospital / Health Plan selected.
Contracted Provider:
Yes
No
Note:
Only contracted providers will be able to add additional users after successful login.
I acknowledge and I am requesting electronic access to the Conifer Health Solutions provider portal.
I understand that my access and any staff member's access is a privileged right and I and my staff further understand the legal responsibilities we have to protect the privacy of our patients from unauthorized use of protected health information. We agree to protect our usernames and passwords and will not disclose them to anyone.
Submit
|
Cancel
© 2024 Conifer Health Solutions |
Privacy Policy