CCRI Enrollment Short Form - Westmoreland County 2026

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The document is a guide for completing the Consolidated Community Reporting Initiative (CCRI) Provider Enrollment Application Short Form in Pennsylvania. It is intended for providers already enrolled in Medical Assistance Fee-for-Service or HealthChoices who wish to enroll as CCRI providers. The application requires details such as the effective date of enrollment, provider ID, applicant's name, provider type and specialty, license number, service location, and contact information. It also outlines the submission process to the county representative and includes certification by the provider.

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Click ‘Get Form’ to open the CCRI Enrollment Short Form in our editor.
In the 'Action Requested' section, enter the effective date of enrollment and your 13-digit PROMISe™ provider ID number.
For the 'Enrollee’s Name', provide the applicant's name and date of birth. If using a fictitious business name, attach the necessary documentation.
Fill in the 'Provider Type Number and Description' with the relevant details for your enrollment request.
Complete the 'Provider Specialty Number and Description' fields as applicable to your services.
Enter your professional or state license number in the designated field if required.
List the physical service location where services will be provided, ensuring it is not a P.O. Box.
Indicate where you want correspondence sent in the 'Mail to Information' section.
Sign and date the application, print your name, and provide your telephone number. Ensure that you use black ink for signing.

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What is the average household income in Westmoreland County PA?

Median household income in Westmoreland County, PA was $72,500 from 20192023.

What are the demographics of Westmoreland County PA?

Westmoreland sales tax details The minimum combined 2025 sales tax rate for Westmoreland, Pennsylvania is 6.0%. This is the total of state, county, and city sales tax rates. The Pennsylvania sales tax rate is currently 6.0%.

What is the largest minority in PA?

The 5 largest ethnic groups in Pennsylvania are White (Non-Hispanic) (73.8%), Black or African American (Non-Hispanic) (10.3%), Asian (Non-Hispanic) (3.67%), Other (Hispanic) (2.98%), and Two Races Excluding Other, Three or More Races (Non-Hispanic) (2.49%).

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Is Westmoreland County Republican or Democrat?

Republicans have won the county in every election since, increasing the margin of victory in every successive election until 2020.

Is Westmoreland County, PA a good place to live?

This vibrant county enjoys natural beauty, a great historical legacy, a thriving economy, and pleasant communities. In many ways, Westmoreland County is located in a Goldilocks Zone with the just right blend of convenient access to urban amenities and outdoor recreation opportunities in the scenic Laurel Highlands.