If you have corrections or questions about the information contained in the L.A. CARE HEALTH PLAN provider directory, please complete this form. Name Email Basic Address ZIP/Postal Code Phone Are you an L.A. Care Member or Provider? - Select -L.A. Care MemberL.A. Care ProviderNeither a member or provider What L.A. Care plan are you a member of? - Select -L.A. Care Medi-CalL.A. Care Medicare PlusL.A. Care CoveredL.A. Care Covered DirectPASC-SEIU Plan Member ID Number Provider NPI Number Follow-up Call Please check this box if you would like a follow up call. We can help you understand the results of your report. L.A. Care will only contact you for the purpose of this report. We ask that you complete one report per correction or error. How many errors will you report today? - Select -123 Provider Directory Inaccuracy Report #1 Please complete all the fields. Where did you see the error? - Select -Online Provider DirectoryPrinted Provider Directory A Provider is a primary care physician, specialist, etc. (A person)A Facility is a Hospital, Urgent Care, Clinic, etc. (A place) Is the error related to a Provider (example - an incorrect person name) or Facility (example - an incorrect building address)? - Select -ProviderFacility Facility Details Facility NPI Number Facility Name Type of Facility Inaccuracy - Select -Facility NameFacility TypeFacility AddressFax NumberLanguages SpokenMedical InterpreterOffice HoursNPI NumberState License NumberFacility AccessibilityNetwork AffiliationOther Facility Detailed Explanation Provider Details Provider ID Number Provider Name Type of Provider Inaccuracy - Select -Provider NameMedical GroupProvider GenderProvider TypeProvider SpecialtyProvider LanguageStaff LanguageMedical InterpreterNPI NumberState License NumberAddressPhone/Fax NumberOffice HoursAccepting New PatientsFacility AccessibilityHospital AffiliationOther Provider Inaccuracy Detailed Explanation Provider Directory Inaccuracy Report #2 Please complete all the fields. Where did you see the error? - Select -Online Provider DirectoryPrinted Provider Directory A Provider is a primary care physician, specialist, etc. (A person)A Facility is a Hospital, Urgent Care, Clinic, etc. (A place) Is the error related to a Provider (example - an incorrect person name) or Facility (example - an incorrect building address)? - Select -ProviderFacility Facility Details Facility NPI Number Facility Name Type of Facility Inaccuracy - Select -Facility NameFacility TypeFacility AddressFax NumberLanguages SpokenMedical InterpreterOffice HoursNPI NumberState License NumberFacility AccessibilityNetwork AffiliationOther Facility Detailed Explanation Provider Details Provider ID Number Provider Name Type of Provider Inaccuracy - Select -Provider NameMedical GroupProvider GenderProvider TypeProvider SpecialtyProvider LanguageStaff LanguageMedical InterpreterNPI NumberState License NumberAddressPhone/Fax NumberOffice HoursAccepting New PatientsFacility AccessibilityHospital AffiliationOther Provider Inaccuracy Detailed Explanation Provider Directory Inaccuracy Report #3 Please complete all the fields. Where did you see the error? - Select -Online Provider DirectoryPrinted Provider Directory A Provider is a primary care physician, specialist, etc. (A person)A Facility is a Hospital, Urgent Care, Clinic, etc. (A place) Is the error related to a Provider (example - an incorrect person name) or Facility (example - an incorrect building address)? - Select -ProviderFacility Facility Details Facility NPI Number Facility Name Facility Detailed Explanation Type of Facility Inaccuracy - Select -Facility NameFacility TypeFacility AddressFax NumberLanguages SpokenMedical InterpreterOffice HoursNPI NumberState License NumberFacility AccessibilityNetwork AffiliationOther Provider Details Provider ID Number Provider Name Type of Provider Inaccuracy - Select -Provider NameMedical GroupProvider GenderProvider TypeProvider SpecialtyProvider LanguageStaff LanguageMedical InterpreterNPI NumberState License NumberAddressPhone/Fax NumberOffice HoursAccepting New PatientsFacility AccessibilityHospital AffiliationOther Provider Inaccuracy Detailed Explanation CAPTCHA Submit