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MEDICAID MEMBERS
- - - Become a Member
  - - Contact Us
- - - Neighborhood has been helping Rhode Island families stay healthy for almost 30 years by providing access to excellent health care.
COMMERCIAL MEMBERS
- - - Welcome to Neighborhood’s Commercial Member plan section. If you purchased a health plan through HealthSource RI or have a plan through your small employer, find information about your benefits here.
MEDICARE-MEDICAID MEMBERS
- - - Contact
- - - Welcome! We are happy to offer a health and drug plan for Rhode Islanders eligible for both Medicare and Medicaid — Neighborhood INTEGRITY (Medicare-Medicaid Plan).

Add a New Provider to a Currently Contracted Practice/Group

Please complete the following information to add a new provider in a practice/group that is currently contracted with Neighborhood Health Plan of Rhode Island. If you require a new contract with Neighborhood, please go to the Join our Network web page.
Effective Date*
MM slash DD slash YYYY
Practitioner is enrolled with Rhode Island Medicaid*
Practitioner is enrolled with Rhode Island Medicaid *
- Yes
- No
Per federal requirements, all providers participating in the Neighborhood network are required to be enrolled with Rhode Island Medicaid. If you are currently not enrolled with Rhode Island Medicaid, please visit the Rhode Island Executive Office of Health and Human Services Provider Enrollment Page for additional information on how to enroll: Rhode Island Medicaid Provider Enrollment Application
Group/Entity NPI*
Group/Entity Name*
Group/Entity TIN*
Provider NPI*
Provider Name*
Primary Specialty*
Secondary Specialty
Practice Name*
Practice NPI (if applicable)
Practice Address*
Street Address Address Line 2 City State ZIP Code
Practice Phone*
Emergency/Urgent Care Provider*
Emergency/Urgent Care Provider *
- Yes
- No
Physician Assistant Provider*
Physician Assistant Provider *
- Yes (If yes, click here to complete the required Physician Assistant Attestation. Save this form to your desktop, complete, and attach/upload to this form below)
- No
PA Questionnaire*
Accepted file types: pdf, Max. file size: 200 MB.
Provider role at this location*
Provider role at this location *
- PCP
- Specialist
All providers must submit a Practitioner Attachment. Click here and save this form to your desktop, complete, and attach/upload to this form.
Practitioner Attachment to Neighborhood Agreement*
Drop files here or

Max. file size: 200 MB.
Is the provider accepting new patients at this location?*
Is the provider accepting new patients at this location? *
- Yes
- No
Provider's hours at this location*
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Sunday Hours*
Sunday Hours *
- Custom
- Open 24 Hours
Sunday Open*

: Hours

Minutes

AM/PM
Sunday Close*

: Hours

Minutes

AM/PM
Monday Hours*
Monday Hours *
- Custom
- Open 24 Hours
Monday Open*

: Hours

Minutes

AM/PM
Monday Close*

: Hours

Minutes

AM/PM
Tuesday Hours*
Tuesday Hours *
- Custom
- Open 24 Hours
Tuesday Open*

: Hours

Minutes

AM/PM
Tuesday Close*

: Hours

Minutes

AM/PM
Wednesday Hours*
Wednesday Hours *
- Custom
- Open 24 Hours
Wednesday Open*

: Hours

Minutes

AM/PM
Wednesday Close*

: Hours

Minutes

AM/PM
Thursday Hours*
Thursday Hours *
- Custom
- Open 24 Hours
Thursday Open*

: Hours

Minutes

AM/PM
Thursday Close*

: Hours

Minutes

AM/PM
Friday Hours*
Friday Hours *
- Custom
- Open 24 Hours
Friday Open*

: Hours

Minutes

AM/PM
Friday Close*

: Hours

Minutes

AM/PM
Saturday Hours*
Saturday Hours *
- Custom
- Open 24 Hours
Saturday Open*

: Hours

Minutes

AM/PM
Saturday Close*

: Hours

Minutes

AM/PM
If you are requesting to add the above provider to more than one location, please upload/attach a document that includes, at minimum: Practice Name, Practice NPI (if applicable), Address, Phone, and Fax. Also please indicate whether or not the site is the PCP location. Note: To set-up a new location, use the Add a Practice Location to a Current Group form.
Additional Locations File Upload
Drop files here or

Accepted file types: doc, docx, xls, xlsx, Max. file size: 200 MB.
Office Contact Name*
Office Contact Email Address*
Details for person submitting the form
Name*
Title*
Phone Number*
Email*
Date*
MM slash DD slash YYYY
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