New Provider Interest Form
For Primary Care and Specialty Care Providers Only
If no, please apply for Medicaid ID before completing this form.
A list of our network hospitals are located at medstarfamilychoice.com for Medicaid and medstarprovidernetwork.org for Medicare and Select.

If you would like to print a copy of your submission for your records, click the Preview button below and then print using your browser. When printing is complete, then click the Submit button to submit your form.