​​​​​​​​​​​​​​​​​​​​​​​Provider Enrollment Options

Reference a list of providers that are eligible to enroll through:

• PAVE
  
• PAVE (eligible specialized enrollment options)
• A paper form
  
• The California Department of Public Health
• Other divisions or departments
  

Provider Types Eligible to Enroll Through PAVE

• Acupuncturist
  
• Air Ambulance Transportation
• Ambulatory Surgical Clinic (Physician-Owned)
• Audiologist
• Blood Bank
  
• Certified Mastectomy Fitter
  
• Certified Nurse Midwife
• Certified Nurse Practitioner
• Certified Nurse Practitioner Group
  
• Certified Registered Nurse Anesthetist
  
• Chiropractor
  
• Christian Science Practitioner
  
• Clinical Laboratory
  
• Clinical Nurse Specialist ​
  
• Community-Based Organization (for CHW and AP services)
  
• County Clinic Not Associated with Hospital Exempt From Licensure
  
• Dental Group​
  
• Dentist
  
• Developmental Screening and Trauma 
  
• Diabetes Prevention Program
• Dispensing Optician
  
• Doctor of Medicine
  
• Doctor of Osteopathic Medicine
  
• Doula​
  
• Doula Group
  
• Drug Medi-Cal Clinic
  
• Drug Medi-Cal Clinic Medical Director
  
• Drug Medi-Cal Heroin Detox
• Drug Medi-Cal Licensed Substance Use Disorder Treatment Professional
• Drug Medi-Cal Substance Use Disorder Medical Director
• Durable Medical Equipment
  
• Exempt from Licensure Clinic
  
• Fabricating Optical Laboratory
  
• Hearing Aid Dispenser
  
• Hospice Providers for Palliative Care Services 
  
• Independent Diagnostic Testing Facility (IDTF)
  
• Licensed Clinical Social Worker
• Licensed Clinical Social Worker Group​
  
• Licensed Individual Drug Medi-Cal Clinic Professional
  
• Licensed Marriage and Family Therapist
• Licensed Marriage and Family Therapist Group
• ​Licensed Midwife
  
• Licensed Professional Clinical Counselor
  
• Licensed Professional Clinical Counselor Group
  
• Local Health Jurisdiction (for CHW and AP services)
  
• Medical and Non-Medical Ground Transportation
• Nurse Practitioner (Supervised)
• Occupational Therapist
• Ocularist
• Optometrist
• Optometrist Group
  
• Orthotist
  
• Outpatient Heroin Detox Center​​​
  
• Out of State Hospital (Inpatient)
• Out of State Hospital (Outpatient)
• Pharmacy/Pharmacist
  
• Physician Assistant (Supervised)
• Physician/Surgeon
• Physician/Surgeon (Group)
  
• Physical Therapist
• Podiatrist
• Portable Imaging
  
• Prosthetist
• Prosthetist/Orthotist Group
• Psychologist
• Psychologist Group
  
• Registered Dental Hygienists
  
• Registered Dental Hygienists in Alternative Practice
  
• Registered Dental Hygienists in Extended Functions 
  
• Respiratory Care Practitioner
  
• Respiratory Care Practitioner Group
• Speech Language Pathologist
  
• Tribal Health Services
  
• University Dental Provider
  

PAVE-Eligible Specialized Enrollment Options (For Applicable Provider Types)

• Clinic-Based Provider
• Facility-Based Provider
• Hospital-Based Provider
• Medicare Crossover-Only Provider
• Ordering, Referring, Prescribing (ORP) Provider​
  
• Out of State Provider
  
• Rendering Provider
  

Provider Enrollment Requests Completed via Paper Forms

• Change of National Provider Identifier (Varies by Provider Type. To find out more, call (916) 323-1945 or submit an Inquiry Form)
• PIN Verification Request (DHCS 6209)
• Change of Ownership or Location for Exempt from Licensure Clinics that have become FQHC/RHC

Provider Types Eligible to Enroll Through California Department of Public Health

Visit the California Department of Public Health to enroll:

• Adult Day Health Care (ADHC) Center
  
• Alternative Birth Centers - Specialty Clinic
• Birthing Center Services
• Blood Bank
  
• Certified Hospice
• Chronic Dialysis Clinic
• Community Clinic
• Community Hospital (Inpatient)
• Community Hospital (Outpatient)
• County Clinics Not Associated with Hospital
• County Hospital (Inpatient)
• County Hospital (Outpatient)
  
• Free Clinic​
• Health Access Program
  
• Heroin Detox Clinic​
  
• Home Health Agency
• Home and Community Based Services Nursing Facility
• Hospice
  
• Long Term Care Facility
  
• Mental Health Inpatient Facility Rehabilitation Clinic 
  
• Multi-Specialty Clinic
• Otherwise Undesignated Clinic
  
• Pediatric Subacute Care LTC
• Rehabilitation Clinic
• Residential Care Facilities for the Elderly (RCFE)
  
• Rural Health Clinics/Federally Qualified Health Clinic
• Surgery Center (Physician-Owned and Non Physician-Owned) or Surgical Clinic

Provider Types Eligible to Enroll Through other Divisions/Departments

• AIDS Waiver Services (DHCS - Office of AIDS)
• Breast Cancer Early Detection Program (DHCS - Breast and Cervical Cancer Treatment Program)
• Care Coordinator Agency (DHCS - Integrated Systems of Care)
• CCS/GHPP Institutional (DHCS - Integrated Systems of Care)
• CCS/GHPP Non-Institutional (DHCS - Integrated Systems of Care)
  
• Community-Based Adult Services (Department of Aging​)
  
• Electronic Health Records Incentive Program (​DHCS - ​Health Information Management Division​)
  
• Employment Agency (DHCS - Safety Net Financing)​​
  
• EPSDT Supplemental Services Provider (DHCS - Integrated Systems of Care​) 
  
• Expanded Access to Primary Care Clinic (DHCS - Primary and Rural Health Division)
  
• Genetic Disease Testing (DHCS - Benefits Division)
  
• HCBS Benefit Program (DHCS - Integrated Systems of Care)
• Home and Community-Based Services Nursing Facility (Home and Community-Based Alternatives Waiver [HCBA]-Congregate Living Health Facility [CLHF]) (DHCS - Safety Net Financing)
  
• Indian Health Services (DHCS - Primary and Rural Health Division​)
  
• Individual Nurse Providers (DHCS - Integrated Systems of Care​)
  
• Local Education Agency (DHCS - Safety Net Financing)
  
• Mental Health Inpatient Services (DHCS - Mental Health Services)
• Multi-Purpose Senior Services Program (Department of Aging)
  
• Personal Care Agency (DHCS - Integrated Systems of Care)
  
• Private Non-Profit Proprietary Agency (DHCS - Integrated Systems of Care)
  
• Professional Corporation (DHCS - Integrated Systems of Care)
  
• Unified School District (DHCS - ​Integrated Systems of Care​)