Provider Enrollment on the Portal Instructions

Your Selections
As you progress through these pages, your selections will be shown below. To edit a selection, click the edit link next to the item you would like to change.
Application Type
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Program(s)
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Enrolling As
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Provider Type Selection

Based on the information you provided (shown at left), you may enroll as one of the following provider types. Select only one option, then click the "Continue" button below.