HealthVet

Provider Eligibility Check

Let's first determine if you qualify to join the VA Community Care Network.

Are you currently licensed to practice in your state?

Yes, I have an active license No, I do not have an active license

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Basic Information

Tell us about yourself

First Name *

Last Name *

Email Address *

Phone Number *

NPI Number *

Create Password *

At least 8 characters with a mix of letters and numbers

Confirm Password *

Practice Details

Tell us about your practice

Practice Name *

Practice Type *

Primary Specialty *

Practice Address *

Professional Credentials

Verify your professional qualifications

Medical License Number *

License State *

DEA Number (if applicable)

Malpractice Insurance Carrier *

Policy Number *

Verification & Attestation

Please review and confirm the following statements

By submitting this application, I attest that:

All information provided in this application is true and accurate to the best of my knowledge I am currently licensed to practice in my state with no active sanctions or restrictions I maintain current malpractice insurance coverage I am enrolled in Medicare or have a valid opt-out affidavit on file I understand that false statements may result in denial of enrollment and potential legal action

Electronic Signature *

By typing your name above, you are electronically signing this application

Application Submitted Successfully!

Thank you for applying to join the VA Community Care Network.

What happens next?

We'll review your application within 5-7 business days
You'll receive an email with your application status
If approved, you'll receive onboarding instructions

Go to Provider Dashboard

Please correct the following errors: