The information in this online directory is updated at least monthly. The availability of physicians, hospitals, providers and services may change day-to-day. For the most up-to-date information, please contact PHP Customer Service at 800-878-4445, 8 a.m. to 5 p.m. Monday-Friday. Information about providers is provided to us directly by the providers or is obtained as part of the credentialing process.
Providence makes every effort to ensure that this list of providers is up to date and accurate. Information listed in this directory is not guaranteed and may be subject to change without notice. For the most up-to-date information, please verify that the provider you have selected is covered by your plan. You may do this by contacting customer service at 800-878-4445 or by calling the provider prior to scheduling an appointment to verify that he or she is covered by your plan and is accepting new patients.
To request a printed copy of our provider directory, or please call Customer Service at 800-878-4445, 8 a.m. to 5 p.m. Monday-Friday, Providence Health Plan will mail a hard copy of the provider directory to you within three (5) business days of your request. Providence Health Plan may ask whether your request for a hard copy is a one-time or permanent request. Customer Service can also provide information about practitioner race/ethnicity upon request.
To report information you believe to be listed inaccurately in the provider directory, please call 800-878-4445, send an email to PHPPRcontactus@providence.org or login to your myProvidence account and use the secure chat feature. Please be sure to have the provider(s) and/or facility name, location and description of the error available.
Practitioners and hospitals in the Providence Health Plan networks must meet Providence Health Plan credentialing requirements. Providence Health Plan does not currently use specific quality measures, member experience measures, patient safety measures or cost-related measures to determine our networks, including our Marketplace networks.
Important Mental Health and Substance Use Disorder Treatment Information
Carrier discipline findings by WA OIC for failure to meet access standards: None issued to date
Plan enrollees may file a complaint with the Washington Office of the Insurance Commissioner by calling the commissioner's toll-free insurance consumer hotline at 1- 800-562-6900 or https://www.insurance.wa.gov/file-complaint-or-check-your-complaint-status
For information concerning any disciplinary action or malpractice history for Washington providers, please use this link: https://fortress.wa.gov/doh/providercredentialsearch/
Providers’ full names are reviewed during the credentialing process when a provider first joins the health plan and every three years after.
End of dialogue content.Return to ContentNPI number is for provider identification purposes only, not to be used for claims payment.
End of dialogue content.Return to ContentAll providers are assumed to speak English. Some providers are fluent in other languages as well. If a provider has another language listed it means the provider speaks the language(s) listed. The provider’s office self-reports this information and it is as current as the last report. The information accuracy is subject to the provider’s input.
End of dialogue content.Return to ContentGender information is submitted when a provider joins the health plan and every three years thereafter. This information is furnished by the provider and the accuracy is subject to the provider’s input.
End of dialogue content.Return to ContentThe health plan checks provider education and training during the initial credentialing process. This includes verification of:
1. Graduation from medical or professional school
2. Residency, if appropriate
3. Board certification, if appropriate
The following may be used to verify training and education:
Board certification is an extra step many doctors chose to take. To become board certified, a doctor must complete the necessary educational requirements and a residency training in their specialty, pass an exam, and meet all the requirements established by their specialty board. A doctor that has a board certification listed is certified or approved by that medical specialty board.
Board certifications are verified with one of the following:
The health plan verifies a provider’s board certification when the provider first contracts with the health plan and every three years following. Board certification is verified through the sources listed above. No other certifications are verified. Information is as accurate as of the date the provider was last credentialed.
End of dialogue content.Return to ContentIf a provider has a hospital listed it means they are on the medical staff of that hospital and have the ability to treat you and other patients at that hospital. The information is self-reported by the provider and the accuracy is subject to the provider’s input.
Hospital affiliation participation details are received during the provider credentialing process when they join the health plan and every three years thereafter. The information is as accurate as the last credentialing cycle performed for the provider.
End of dialogue content.Return to ContentIf a provider has a specialty listed it means the provider has completed education and training in a specific area of medicine. Examples of specialties include Cardiology, Dermatology, Family Practice, Pediatrics, Internal Medicine. Providers are trained in fields of medicine that focus on a range of services, procedures, body systems or patients. The provider self-reports his/her specialty information and the health plan further verifies by their board certification status or licensing board. Provider specialties are reviewed by the health plan during the credentialing process when a provider first joins the health plan and every three years after. The information is as accurate as the last credentialing cycle completed for the provider.
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Medical Group Affiliation
If a provider has a clinic or group listed it means they are a part of that medical group which includes two or more providers. The health plan may contract with the individual
provider or the group. The provider’s office self-reports this information and it is as current as the last report. The information accuracy is subject to the provider’s input.
Office Location
This is the street address and phone number of the provider. The information is provided when they join the health plan and every three years thereafter. The provider’s office self-reports this
information and it is as current as the last report. The information accuracy is subject to the provider’s input.
All clinic staff are assumed to speak English. Some clinic staff members are fluent in other languages as well. If a provider has another language spoken by clinic staff listed it means that someone with in the provider’s clinic staff speaks the language(s) listed. The provider’s office self-reports this information and it is as current as the last report. The information accuracy is subject to the provider’s input.
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