L.A. Care Direct Network Form

Thank you for your interest in becoming an L.A. Care Health Plan network provider. This form is necessary to perform an initial assessment to confirm your eligibility for participation. The L.A. Care Direct Network is our directly contracted network.  Physicians can see L.A. Care members without being affiliated with an IPA.

Are you either an individual or group practice?: *

Are you either an individual or group practice?

Select if you are either PCP, Specialist, Both (Multi-specialty group): *

Select if you are either PCP, Specialist, Both (Multi-specialty group)

More information

  • Files must be less than 25 MB.
  • Allowed file types: pdf doc docx xls xlsx.