*First Name

*Last Name

*Upload professional image

NOTE: Photos must meet the following criteria:

• Formal headshot in a white coat or professional attire.
• Image files must be in .jpg, .gif or .tiff format (at a resolution of at least 300 dpi).
• The image must be at least 500 pixels wide and less than 3mb in file size.

If you need a professional photo taken, please contact your affiliated hospital’s Marketing Dept. and they can arrange for your photo.

*Procedures

*Conditions Treated

*Care Philosophy

*Accepted Health Plans

AARP Healthcare	Active Care (Workers' Comp)
Aetna	Aetna Better Health
Aetna Health Plans of NJ	Aetna Medicare NNJ Prime
America’s Health Plan	Amerigroup (managed Medicaid plan)
AmeriHealth	Anthem Health
Beacon	BeechStreet PPO
Blue Cross/Blue Shield NJ	Braven Health
Charity Care Accepted	Cigna
Cigna Behavioral Health	Cigna Healthcare/Great West
Community Care Network	Consumer Health Plan
Coventry	Devon Health Services
Emblem Health/GHI	Emblem Health/QualCare
Empire BCBS	Empire Health Choice
Empire through Blue Card Program	Evolutions Health Systems
First Health Network	First Managed Care Option
First MCO (Workers' Comp)	Galaxy Health Care
GHI	GHI PPO
GHI through Qualcare (Only for patients where the Qualcare logo appears on the ID card)	Great-West (Cigna)
Health New Federal Services	Health Republic Insurance of NJ
HealthNet Federal Health Services (TriCare-Champus)	HIP PPO
Horizon BCBS	Horizon BCBS HMO
Horizon BCBS Indemnity	Horizon BCBS Medicare Blue
Horizon BCBS Omnia	Horizon BCBS PPO
Horizon Casualty Services (Workers Comp & No Fault)	Horizon NJ Health (managed Medicaid plan)
Independence BCBS	Intergroup Services Corp
Magellan Behavioral Health (B)	Magnacare
Managed Health Network (B)	MCS Patient Centered Health Care Network
Medicaid	Medicare
Multiplan	Multiplan/ PHCS
Multiplan/Beechstreet/PHCS/Viant	National Health Plan
National Preferred Provider Network (NPPN)/Planned Care America	National Provider Network
New Jersey Carpenters Health Fund (B)	New Jersey Manufacturers through Horizon Casualty
No Insurance Accepted	Optum Behavioral Health
Oxford	Oxford Health
Oxford Health HMO	Oxford Health PPO
Oxford Medicare Advantage Plans	Oxford Medicare Advantage Private Fee For Service Plans (PFFS)
Private Health Care Systems (PHCS)	QualCare
QualCare Workers Comp	Railroad Medicare
Tricare	United Behavioral (B)
United Community	United Healthcare
United Healthcare Community Plan (formerly Americhoice Managed Medicaid)	United Medicare Advantage Plans
United Medicare Advantage Private Fee For Service Plans (PFFS)	US Family Health Plan (Tricare Prime)
US Family Plan	Value Options (B)
Wellcare	Wellcare Managed Medicaid (Family Care)
Wellcare Managed Medicare

*Affiliations

Please select all RWJBarnabas Health facilities you are affiliated with:

Childrens Hospital of New Jersey at Newark Beth Israel Medical Center	Childrens Specialized Hospital
Clara Maass Medical Center	Community Medical Center
Cooperman Barnabas Medical Center	Jersey City Medical Center
Monmouth Medical Center	Monmouth Medical Center, Southern Campus
Newark Beth Israel Medical Center	Robert Wood Johnson Medical School
Robert Wood Johnson University Hospital	RWJ University Hospital Hamilton
RWJ University Hospital Rahway	RWJ University Hospital Somerset
RWJBarnabas Health Medical Group	The Bristol-Myers Squibb Childrens Hospital at RWJUH
The Unterberg Childrens Hospital at Monmouth Medical Center	Trinitas Regional Medical Center

Please confirm security question above