TennCare Provider Registration Portal
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Registration
Provider information entered here will be submitted to CAQH to collect the information needed by TennCare for assigning a Medicaid ID.
Make sure to click SUBMIT once all information has been entered. CAQH ProView:
https://proview.caqh.org/Login
PROVIDERS:
Please review the
Electronic Registration
Personal Information
* First Name
Middle Name
* Last Name
Suffix
* Birth Date
* SSN
Professional Identification
* Provider Type
Acupuncturist
Advance Practice Nurse
Alcohol/Drug Counselor
Anesthesia Assistant
Applied Behavioral Analyst
Athletic Trainers
Audiologist
Certified Registered Nurse Anesthetist
Clinical Nurse Specialist
Clinical Psychologist
Dietitian
Doctor of Chiropractic (DC)
Doctor of Dental Medicine (DMD)
Doctor of Dental Surgery (DDS)
Doctor of Podiatric Medicine (DPM)
Genetic Counselor
Hospitalist
Lactation Consultant – IBCLC/RLC
Lactation Consultant/Educator – Certified (CLC/CLE/CLS/CBS)
License Clinical Social Worker
Licensed Master Social Worker
Marriage/Family Therapist
Medical Doctor (MD)
Midwife
Neuropsychologist
Nurse Midwife
Nurse Practitioner
Nutritionist
Occupational Therapist
Optician
Optometrist
Osteopathic Doctor (DO)
Pharmacist
Physical Therapist
Physician Assistant
Professional Counselor
Registered Dental Hygienist
Respiratory Therapist
Speech Pathologist
Surgical Assistant
* Primary Practice State
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
* Provider NPI
*
* License Number
* License State
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
DEA
UPIN
Credentialing Contact Information
* Address
Address 2
* City
* State
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Guam
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Virgin Islands
Vermont
Washington
Wisconsin
West Virginia
Wyoming
* Zip (First 5)
Ext Zip (Last 4)
* Phone No
Phone Extension
* E-mail
* Confirm E-mail
Label
Label
Title
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