Provider Enrollment

MDH Provider Enrollment no longer accepts paper applications. Providers must enroll via ePREP at ePREP.health.maryland.gov. You may also click on the "ePREP" link next to your provider type to enroll.

For more information about ePREP, please visit health.maryland.gov/ePREP.

To access application addenda, please click on the "X" next to the appropriate provider type.

To view the Maryland Medicaid Provider Agreement, click here.

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
AUDIOLOGY PROVIDER	19	ePREP	ePREP	ePREP
AMBULATORY SURGERY CENTER	39			X
ADAA CERTIFIED ADDICTIONS OUTPATIENT PROGRAM	50			X
ACUPUNCTURE	AC	ePREP	ePREP
AMBULANCE COMPANY	T1			X
AUTISM WAIVER	40			X
APPLIED BEHAVIOR ANALYSIS	AB	ePREP	ePREP

B

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
BRAIN INJURY WAIVER	86			X

C

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
CHIROPRACTOR	13	ePREP	ePREP
CLINIC, ABORTION	30			ePREP
CLINIC, DRUG	32			X
CLINIC, FAMILY PLANNING	33			ePREP
CLINIC, RURAL	37			ePREP
CLINIC, LOCAL HEALTH DEPARTMENT	35			X
CLINIC, GENERAL	38			X
CLINIC, FEDERALLY QUALIFIED HEALTH CENTER	34			X
CASE MANAGEMENT - NOT ELSEWHERE CLASSIFIED	81			ePREP
CERTIFIED PROFESSIONAL COUNSELOR	CC	ePREP
COMMUNITY OPTIONS - ASSISTED LIVING (ALF)	76			X
COMMUNITY OPTIONS - OTHER	76			X
CENTERINGPREGNANCY	N/A	X	X

D

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
DIALYSIS FACILITIES	61			X
DMS/DME PROVIDER	62			X
DIAGNOSTIC SERVICES, OTHER	60			X
DIETITAN/NUTRITIONIST.	85	ePREP	ePREP
DDA SERVICES PROVIDER NEW ENROLLEES	90			X
DENTAL PROVIDER	14	X	X
DIABETES PREVENTION PROGRAM (DPP) PROVIDER	DP			X
DOULA	DL	X	X

E

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
EPSDT THERAPEUTIC BEHAVIORAL SERVICES	51			X

F

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
FREESTANDING BIRTH CENTER	31			ePREP
FREESTANDING ONCOLOGY CENTER	36			X

H

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
HOSPITAL - SPECIAL OTHER CHRONIC	7			X
HOSPITAL - SPECIAL OTHER ACUTE	6			X
HOSPITAL - CHRONIC	5			X
HOSPITAL - CHRONIC REHABILITATION	4			X
HOSPITAL - ACUTE	1			X
HOSPITAL - ACUTE REHABILITATION	3			X
HOME HEALTH AGENCY	41			X
HMO/PACE	70			ePREP
HOSPICE PROVIDER	71			ePREP
HEALTHCHOICE MANAGED CARE ORGANIZATION	72			ePREP
HOME AND COMMUNITY BASED SERVICES 1915i	89			X
HIV CASE MANAGEMENT	VC			X
HOME AND COMMUNITY BASED SERVICES 1915i	HG	X	X
HOME VISITING SERVICES	HV			X
HEALTHYSTEPS	N/A	X	X

I

PROVIDER TYPE DESCRIPTION	PT CODE	FACILITY
INTERMEDIATE CARE FACILITY - ADDICTION	55	X
INTERMEDIATE CARE FACILITY - ID	56	ePREP
IMD RESIDENTIAL SUD ADULT	54	X

L

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
LABORATORY	10			ePREP
LOCAL EDUCATION AGENCIES/LOCAL LEAD AGENCY	91			X

M

PROVIDER TYPE DESCRIPTION	PT CODE	GROUP	FACILITY
MENTAL HEALTH GROUP THERAPY PROVIDER	27	ePREP
MEDICAL DAY CARE - CHILDREN	43		ePREP
MEDICAL DAY CARE - ADULTS	42		X
MENTAL HEALTH CLINIC	MC		X
MOBILE TREATMENT PROGRAM	MT		X
MENTAL HEALTH CASE MANAGEMENT PROVIDER	CM		X
MEDICARE CROSSOVER ONLY	XV		X

N

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
NURSE PRACTITIONER	23	ePREP	ePREP
NURSE MIDWIFE	22	ePREP	ePREP
NURSE ANESTHETIST	21	ePREP
NURSE PSYCHOTHERAPISTS	24	ePREP
NURSING FACILITY	57			X

O

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
OCCUPATIONAL THERAPIST	18	ePREP	ePREP

P

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
PODIATRY PROVIDERS	11	ePREP	ePREP
PSYCHOLOGIST	15	ePREP
PHYSICAL THERAPIST	16	ePREP	ePREP
PHYSICIAN	20	ePREP	ePREP
PERSONAL CARE MONITOR	47			ePREP
PEDIATRIC NURSING/HOME HEALTH AIDE SERVICES AGENCY	53			X
PORTABLE X-RAY	59			X
PHYSICIAN ASSISTANT	80	ePREP
PRESCRIBING PROVIDER	92	X
PSYCHIATRIC REHAB SERVICES FACILITY	PR			X
PHARMACY	RX			ePREP
PARTIAL HOSPITALIZATION PROGRAM	MH			X
PAIN MANAGEMENT	N/A		X
PHARMACIST PRESCRIBER	PH	ePREP	ePREP

R

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
RESIDENTIAL TREATMENT CENTER	88			X

S

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
SPEECH/LANGUAGE PATHOLOGIST	17	ePREP	ePREP
SOCIAL WORKER	94	ePREP
STEPS CASE MANAGEMENT	81			ePREP
SCHOOL BASED HEALTH CENTER (SBHC)	N/A		X
SUPPORTED EMPLOYMENT	SE			X

T

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
THERAPY GROUP PROVIDER - EPSDT (PT. OT. SPEECH)	28		ePREP

U

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
URGENT CARE CENTER	8			X

V

PROVIDER TYPE DESCRIPTION	PT CODE	INDIVIDUAL	GROUP	FACILITY
VISION CARE PROVIDER	12	ePREP	ePREP	ePREP

Provider Enrollment

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