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Physician Practitioner Application

Thank you for your interest in becoming a SummaCare Network Provider.

Please complete the physician/practitioner application.

Please note:

  • This includes new provider requests, as well as when adding providers to an existing contracted tax ID.
  • Incomplete applications will not be accepted



  • Your application will be reviewed for service area, specialty, provider type, services provided and network need.
  • If approved, a contract will be sent to the representative listed on the application.
  • If denied, the representative listed on the application will be notified of the denial.


IMPORTANT NOTE:  Once you return the signed contract back to us stating that the contract terms are agreed upon, we will begin the credentialing process.  You cannot see members until you successfully complete the credentialing process.

Credentialing for Physicians / Practitioners:

Physicians and practitioners must have a CAQH (Council for Affordable Quality Healthcare) application completed in order to be credentialed. 

Credentialing can take up to 90 days from the date SummaCare receives all requested documentation.

LINK SummaCare Credentialing Requirements Checklist FOR PHYSICIANS.

Upon approval of credentialing, your contract will be assigned an effective date and returned to the representative listed on the application.  Denials will be notified within 30 days of this decision.

Questions regarding your credentialing status should be directed to the credentialing team directly by calling (234) 312-2100, or by email to