Provider Enrollment

Join our network of trusted healthcare professionals

1
Contact & Business Information
2
Contractor Payment Information
3
Required Documents & Contracts
4
Insurance Selection & Contracting Requirements
5
Provider Type
6
Profile & Services
7
Review & Submit

Step 1: Contact & Business Information

Provider's contact info, home address, business details, tax ID, NPI, CAQH, and Medi-Cal status.

Profile Picture *

Upload and crop a profile photo for the directory.

Full Legal Name *

Provider's full legal name.

Phone Number *

Email Address *

Ethnicity *

Optional — required by some insurance rosters (e.g., Hispanic or Latino, Black or African American, Asian, White, etc.)

Date of Birth *

State of Birth *

Home Address — Street *

Home Address — City *

Home Address — State *

Home Address — ZIP Code *

Business Name

If applicable

Website *

If applicable

Booking Link

If applicable

Tax ID or Social Security Number *

Stored securely — admin-only visibility.

NPI Number — Selection *

Choose one: have NPI, request CuraNatal apply, or apply independently.

I have an NPI — type below

I need CuraNatal Health to apply for my NPI

I will apply for my NPI on my own

CAQH ID — Selection *

I have a CAQH ID — type below

I don't have a CAQH ID yet

Medi-Cal Doula Provider Status *

Select one of the three Medi-Cal status options.

I am Medi-Cal approved

I need CuraNatal Health to apply for Medi-Cal on my behalf

I will apply for Medi-Cal on my own

Medi-Cal Application ID

If the provider has already applied, enter the application ID.

Medi-Cal Application Form (upload)

Upload the Medi-Cal application form if available.

Before You Begin

Welcome! To make your application as smooth as possible, please have the following items ready.

Time Commitment

Please set aside approximately 45 minutes to complete this application, which includes mandatory online HIPAA training.

Required Documents

Valid Driver's License or State-issued ID
Current Infant & Adult CPR Certification
Current General & Professional Liability Insurance Certificate
You will need to download several documents, sign them, and email them back to us at credentialing@curanatalhealth.com