Contact Us General IPA Info 994 West Jericho Turnpike, Suite 203 Smithtown, NY, 11787 [email protected] "*" indicates required fields Name* First Last Email* State*New YorkOrganization/Practice Name* Inquiry Type*BillingInterested Practice Care ProviderExisting IPA ProviderGeneral/OtherSpecialty* Location(s)* # of Providers in Practice* Are you currently a member of another IPA?* Yes No Which IPA are you currently a member of?* Do you have an existing case open for this inquiry?* Yes No Please provide the case # Group TIN* Provider Name* Provider NPI* Inquiry Type* Initial Credentialing | Re-Credentialing Timeframe | Status Claim Denials Received by Group | Provider Inaccuracies in Provider Demographics Payer Participation Discrepancies Rate Request | Discrepancies Termination Request Other Brief description of issue*Contact Information*Name, Title, Email, Phone Number Comments*Please let us know what's on your mind. Have a question for us? Ask away.
