Join the Network

If you are in private practice, or are an FQHC, consider joining our network. Providers accept a subset of patients under CCN’s reduced payment system; the number of patients accepted is completely per the provider’s discretion. Even accepting a few patients into your busy practice, when multiplied over our network, provides access to care for numerous individuals lacking insurance. While the introduction of the Affordable Care Act has helped fill this gap, there are still many individuals, including immigrants and others, who are unable to purchase health insurance.

PROVIDER AGREEMENT

YES I AM WILLING TO JOIN THE COMPASSIONATE CARE NETWORK AND HELP. I UNDERSTAND THAT THIS IS ONLY TO PROVIDE NON URGENT OFFICE SERVICES FOR THE UNINSURED. I AGREE TO CHARGE NO MORE THAN $25.00 FOR THE OFFICE VISIT (PRIMARY CARE CONSULTATION) OR $35.00 (SPECIALIST CONSULTATION). I WILL BE ABLE TO SEPARATELY BILL THE PATIENT FOR LABS AND IMAGING SERVICES IN ADDITION TO THIS. IF I DISPENSE MEDICATIONS IN MY OFFICE I WOULD BE ABLE TO CHARGE THE PATIENT, FOR THEM SEPARATELY AS WELL.
ADD ME TO THE CCN PROVIDER LIST.
CHECK THIS BOX IF YOU AGREE THAT ALL STATEMENTS ARE TRUE, AND THAT YOU ACKNOWLEDGE THAT YOU ARE THE PERSON FOR WHO, THIS FORM IS FILLED OUT.

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Select Enroll Type

New Enrollment for 6 months
Renewal Enrollment for 12 months