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

  
  
  
  
  
AUDIOLOGY PROVIDER19ePREPePREPePREP
AMBULATORY SURGERY CENTER39X
ADAA CERTIFIED ADDICTIONS OUTPATIENT PROGRAM50X
ACUPUNCTUREACePREPePREP
AMBULANCE COMPANYT1X
AUTISM WAIVER40X
APPLIED BEHAVIOR ANALYSISABePREPePREP

B

  
  
  
  
  
BRAIN INJURY WAIVER                    86X

C

  
  
  
  
  
CHIROPRACTOR13ePREPePREP
CLINIC, ABORTION30ePREP
CLINIC, DRUG32X
CLINIC, FAMILY PLANNING33ePREP
CLINIC, RURAL37ePREP
CLINIC, LOCAL HEALTH DEPARTMENT35X
CLINIC, GENERAL38X
CLINIC, FEDERALLY QUALIFIED HEALTH CENTER34X
CASE MANAGEMENT - NOT ELSEWHERE CLASSIFIED81ePREP
CERTIFIED PROFESSIONAL COUNSELORCCePREP
COMMUNITY OPTIONS - ASSISTED LIVING (ALF)76X
COMMUNITY OPTIONS - OTHER76X


D

  
  
  
  
  
DIALYSIS FACILITIES61X
DMS/DME PROVIDER62X
DIAGNOSTIC SERVICES, OTHER60X
DIETITAN/NUTRITIONIST.85ePREPePREP
DDA SERVICES PROVIDER NEW ENROLLEES90X
DENTAL PROVIDER14XX


E

  
  
  
  
  
EPSDT THERAPEUTIC BEHAVIORAL SERVICES51X


F

  
  
  
  
  
FREESTANDING BIRTH CENTER31ePREP
FREESTANDING ONCOLOGY CENTER36X

H

  
  
  
  
  
HOSPITAL - SPECIAL OTHER CHRONIC7X
HOSPITAL - SPECIAL OTHER ACUTE6X
HOSPITAL - CHRONIC5X
HOSPITAL - CHRONIC REHABILITATION4X
HOSPITAL - ACUTE1X
HOSPITAL - ACUTE REHABILITATION3X
HOME AND COMMUNITY BASED SERVICES, OTHER40X
HOME HEALTH AGENCY41X
HMO/PACE70ePREP
HOSPICE PROVIDER71ePREP
HEALTHCHOICE MANAGED CARE ORGANIZATION72ePREP
HOME AND COMMUNITY BASED SERVICES 1915i89X
HIV CASE MANAGEMENTVCX
HOME AND COMMUNITY BASED SERVICES 1915iHGXX


I

  
  
  
  
  
INTERMEDIATE CARE FACILITY - ADDICTION55X
INTERMEDIATE CARE FACILITY - ID56ePREP
IMD RESIDENTIAL SUD ADULT54X

L

  
  
  
  
  
LABORATORY10ePREP
LOCAL EDUCATION AGENCIES/LOCAL LEAD AGENCY91X

M

  
  
  
  
  
MENTAL HEALTH GROUP THERAPY PROVIDER27ePREP
MEDICAL DAY CARE - CHILDREN43ePREP
MEDICAL DAY CARE - ADULTS42X
MENTAL HEALTH CLINICMCX
MOBILE TREATMENT PROGRAMMTX
MENTAL HEALTH CASE MANAGEMENT PROVIDERCMX


N

  
  
  
  
  
NURSE PRACTITIONER23ePREPePREP
NURSE MIDWIFE22ePREPePREP
NURSE ANESTHETIST21ePREP
NURSE PSYCHOTHERAPISTS24ePREP
NURSING FACILITY57X


O

  
  
  
  
  
OCCUPATIONAL THERAPIST18ePREPePREP
OXYGEN PROVIDER63ePREP

P

  
  
  
  
  
PODIATRY PROVIDERS11ePREPePREP
PSYCHOLOGIST 15ePREP
PHYSICAL THERAPIST16ePREPePREP
PHYSICIAN20ePREPePREP
PERSONAL CARE MONITOR47ePREP
PEDIATRIC NURSING/HOME HEALTH AIDE SERVICES AGENCY53X
PORTABLE X-RAY59X
PHYSICIAN ASSISTANT80ePREP
PRESCRIBING PROVIDER92ePREP
PSYCHIATRIC REHAB SERVICES FACILITYPRX
PHARMACYRXePREP
PARTIAL HOSPITALIZATION PROGRAMMHX

R

  
  
  
  
  
RESIDENTIAL TREATMENT CENTER88X

S

  
  
  
  
  
SPEECH/LANGUAGE PATHOLOGIST17ePREPePREP
SOCIAL WORKER94ePREP
STEPS CASE MANAGEMENT81X
School Based Health Center (SBHC)N/AX
SUPPORTED EMPLOYMENTSEX


T

  
  
  
  
  
THERAPY GROUP PROVIDER - EPSDT (PT. OT. SPEECH)28ePREP


U

  
  
  
  
  
URGENT CARE CENTER8X


V

  
  
  
  
  
VISION CARE PROVIDER12ePREPePREPePREP