*First Name

*Last Name

*Email Address: (This will not appear on any web site)

*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
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	Centivo
Charity Care Accepted	CHN
Cigna	Cigna Behavioral Health
Cigna Health Springs	Cigna Healthcare/Great West
Cigna Medicare	Clover
Community Care Network	Consumer Health Plan
Coventry	Devon Health Services
DOL	Emblem
Emblem Health/GHI	Emblem Health/QualCare
Empire BCBS	Empire Health Choice
Empire through Blue Card Program	Evolutions Health Systems
Fidelis (WellCare)	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
Horizon BCBS	Horizon BCBS HMO
Horizon BCBS Indemnity	Horizon BCBS Medicare Blue
Horizon BCBS Omnia	Horizon BCBS PPO
Horizon Casualty	Horizon Casualty Services (Workers Comp & No Fault)
Horizon NJ Health	Horizon NJ Health (managed Medicaid plan)
Humana Medicare	Humana Tricare
Independence BCBS	Intergroup Services Corp
Longevity	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
Northwell	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	UHC/OX
UHCCP	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
US Family Health Plan (Tricare Prime)	US Family Plan
Value Options (B)	Wellcare
Wellcare Managed Medicaid (Family Care)	Wellcare Managed Medicare
WellPoint (Amerigroup)

*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

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