GENERAL INFORMATION MISSING - Tufts Health Plan 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information in the 'Name' section. Fill in your last name, first name, and middle name as required.
3. Provide your Individual NPI, degree/specialty, date of birth, and social security number in the designated fields.
4. Complete the 'Provider’s email' and 'DBA, Group or Practice Name' sections. Indicate if you are joining a group practice by selecting YES or NO.
5. Fill out the CAQH Information section. Ensure that your CAQH application is updated and reattested within the last three months.
6. In the Payment Information section, provide your Payee NPI and Tax ID number. Specify to whom checks should be made payable and include the payment address.
7. Complete all address fields for practice locations, including service hours and any additional contact information as needed.
8. Check all applicable types of practitioners in the TYPE OF PRACTITIONER section and attach any required credentialing documents at the end of the form.

Start filling out your form today for free using our platform!