*First Name *Last Name *Email Address: (This will not appear on any web site) *Primary Specialty *Primary Specialty Acupuncture Addiction Medicine Addiction Psychiatry Adolescent Medicine Allergy & Immunology Anesthesiology Anesthesiology-Cardiac Blood Banking/Transfusion Medicine Bloodless Medicine Cardiology Cardiology-Adult Congenital Heart Disease Cardiology-Advanced Heart Failure and Transplant Cardiology-Interventional Clinical BioChemical Genetics Clinical Cardiac Electrophysiology Clinical Neurophysiology Critical Care Medicine Cytopathology Dentistry-Endodontics Dentistry-General Dentistry-Implant Dentistry-Oral Surgery Dentistry-Orthodontics Dentistry-Periodontics Dermatology Dermatopathology Electromyography Emergency Medicine Endocrinology-Diabetes & Metabolism Epilepsy Ethicist Family Medicine Gastroenterology Geriatric Medicine Gynecologic Oncology Gynecology Hematology Hematopathology Hospice and Palliative Medicine Infectious Disease Integrative Medicine Internal Medicine Interventional Pulmonology Joint Reconstruction-Adult Maternal & Fetal Medicine Medical Genetics Medical Oncology Medical Toxicology Neonatal-Perinatal Medicine Nephrology Neurodevelopmental Disabilities Neurology Neurology-Electrodiagnostic Medicine Neuromuscular Medicine Neuropathology Neurophysiological Monitoring Neurophysiology-Clinical Neuroradiology Nuclear Medicine Nuclear Radiology Nutrition OB/GYN Occupational Medicine Occupational Therapy Ophthalmology Ophthalmology-Pediatrics Optometry Orthopedics Otolaryngology/Ear-Nose-Throat Pain Medicine Pain Medicine-Anesthesiology Pathology Pathology-Anatomical & Clinical Pathology-Chemical Pathology-Forensic Pathology-Medical Microbiology Pathology-Molecular Genetic Pathology-Oral Pediatric Rehabilitation Medicine Pediatric-Anesthesiology Pediatric-Cardiology Pediatric-Cardiothoracic Surgery Pediatric-Child Abuse Pediatric-Critical Care Pediatric-Dentistry Pediatric-Developmental/Behavioral Pediatric-Emergency Medicine Pediatric-Endocrinology Pediatric-Gastroenterology Pediatric-Genetics Pediatric-Hematology/Oncology Pediatric-Infectious Disease Pediatric-Intensive Care Pediatric-Nephrology Pediatric-Neurology Pediatric-Neurosurgery Pediatric-Orthopedic Surgery Pediatric-Otolaryngology Pediatric-Pulmonology Pediatric-Radiology Pediatric-Rheumatology Pediatrics Pediatric-Surgery Pediatric-Urology Pedodontics Perinatology Physical Medicine & Rehabilitation Physical Medicine and Rehabilitation-Electrodiagnostic Medicine Podiatry Prosthodontics Psychiatry Psychiatry-Child & Adolescent Psychiatry-Geriatric Psychology Psychosomatic Medicine Pulmonary Disease Pulmonary-Critical Care Radiation Oncology Radiology Radiology-Diagnostic Radiology-Interventional Radiology-Vascular & Interventional Rehabilitation Medicine Reproductive Endocrinology/Infertility Rheumatology Sleep Medicine Spinal Cord Injury Medicine Sports Medicine Surgery-Arthroscopy Surgery-Bariatric Surgery-Bloodless Surgery-Breast Surgery-Burn Surgery-Colon & Rectal Surgery-Critical Care Surgery-Endoscopy Surgery-General Surgery-Hand Surgery-Head-Neck & Facial Plastic Surgery-Laser Surgery-Micro Surgery-Minimally Invasive Surgery-Neurological Surgery-Oncology Surgery-Ophthalmology Surgery-Oral & Maxillofacial Surgery-Plastic Surgery-Refractive Surgery-Robotic Surgery-Spine Surgery-Thoracic & Cardiac Surgery-Total Joint Replacement Surgery-Vascular Transplantation Undersea & Hyperbaric Medicine Urogynecology Urology Vascular Neurology Wound Care *NPI # *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 HealthcareAARP Medicare Complete (HMO)AARP MedicareComplete Essential (HMO)AARP MedicareComplete Plan 1 (HMO)AARP MedicareComplete Plan 2 (HMO)AARP MedicareComplete Plan 3 (HMO)AARP MedicareComplete Plan 4 (HMO)Active Care (Worker's Comp)AetnaAetna Better HealthAetna Choice POS IIAetna DentalAetna Elect ChoiceAetna EPOAetna First HealthAetna Health Plans of NJAetna HMOAetna Indemnity plans with network incentivesAetna Joint Claims AdministrationAetna Managed Choice POSAetna MedicareAetna Medicare NNJ PrimeAetna Medicare Plan (HMO)Aetna Medicare Plan (PPO with Extended Service)Aetna Medicare Plan (PPO)Aetna Meritain/Meritain Shared Administrative ServicesAetna Open ChoiceAetna Passport to Healthcare®and National AdvantageAetna Passport to Healthcare®and National Advantage ProgramAetna POSAetna PPOAetna QPOSAetna SelectAetna Signature administrators®Aetna Student HealthAetna US Health CareAmerican Postal Workers UnionAmerica's Health PlanAmerichoiceAmerigroupAmerigroup (Managed Medicaid Plan)AmerihealthAnthem HealthAnthem Health of NYBankers Life and CasualtyBeaconBeech StreetBeechStreet PPOBenefit Planners InsuranceBenesightBlue Cross Blue Shield OmniaBlue Cross/Blue Shield NJBraven HealthCentivoCharity Care AcceptedCHNCignaCigna Behavioral HealthCigna Health SpringsCigna HealthcareCigna Healthcare of New Jersey – Northern NJ HMOCigna Healthcare/Great WestCigna HMOCigna MedicareCigna Open Access Plus, Choicefund OA PlusCigna Open Access Plus, OA Plus, Choicefund OA Plus with CareLinkCigna PPO, Choicefund PPOCigna Seamless – Metro New YorkCloverClover HealthCommunity Care NetworkConsumer Health PlanCoventryDelta DentalDevon Health ServicesDOLEmblemEmblem Health / GHIEmblem Health / QualCareEmpire BC/BSEmpire HealthchoiceEmpire through Blue Card ProgramErickson Advantage Champion (HMO-POS SNP)Erickson Advantage Freedom (HMO-POS)Erickson Advantage Guardian (HMO-POS SNP)Erickson Advantage Signature with Drug (HMO-POS)Erickson Advantage Signature without Drug (HMO-POS)Evolutions Health SystemsFamily Choice Health AllianceFederal Blue Cross PPOFidelis (WellCare)First Health NetworkFirst Managed Care OptionFirst MCO (Worker's Comp)First MCO/Active CareFocus HealthcareGalaxy Health CareGalaxy Health NetworkGenworthGHIGHI PPOGHI through QualCare (only for patients where the Qualcare logo appears on ID card)Great West HealthcareGreat-West (Cigna)Guardian Resources Inc.Health NetHealth Network America Inc.Health New Federal ServicesHealth Republic Insurance of NJHealthcare Payers CoalitionHealthcare Payors OrganizationHealthfirst of New JerseyHealthNet Federal Health Services (TriCare-Champus)HIP PPOHMO Blue - Medicare BlueHorizonHorizon Advantage EPOHorizon BCBSHorizon Blue Cross Blue Shield HMOHorizon Blue Cross Blue Shield IndemnityHorizon Blue Cross Blue Shield Medicare BlueHorizon Blue Cross Blue Shield of NJHorizon Blue Cross Blue Shield OmniaHorizon Blue Cross Blue Shield PPOHorizon CasualtyHorizon Casualty Services (Worker's Comp & No Fault)Horizon Direct AccessHorizon EPO/EPO PlusHorizon HMOHorizon Managed CareHorizon Medicare Blue (PPO)Horizon Medicare Blue Access (HMO-POS)Horizon Medicare Blue Advantage (HMO)Horizon Medicare Blue Choice w/Rx (HMO)Horizon Medicare Blue Group (PPO)Horizon Medicare Blue Group w/Rx (PPO)Horizon Medicare Blue Value (HMO)Horizon Medicare Blue Value w/Rx (HMO)Horizon MyWay HRA Direct AccessHorizon MyWay HRA PPOHorizon MyWay HSA Direct AccessHorizon MyWay HSA PPOHorizon NJ HealthHorizon NJ Health (managed Medicaid plan)Horizon Patient-Centered Adv EPOHorizon POSHorizon PPOHorizon Traditional/IndemnityHumana MedicareHumana TricareIndependence BCBSIntergroup ServicesLiberty MutualLocal 1199Local 464/MaxonLocal 734Local 825 Welfare FundLongevityLutheran Senior HealthcareMagellanMagellan Behavioral HealthMagnacareMagnacare/MagnetMail Handlers Benefit PlanManaged Health NetworkMCS Patient Centered Health Care NetworkMedicaidMedicareMetlifeMultiplanMultiplan / PHCSMultiplan/Beechstreet/PHCS/ViantMultiplan/PHCS SavilityMutual of OmahaNational Association of Letter CarriersNational Health PlanNational Preferred Provider Network (NPPN)/Plan Care AmericaNational Provider NetworkNew Jersey Carpenters Health FundNew Jersey ManufacturersNew Jersey Manufacturers through Horizon CasualtyNew Jersey PlusNJ 21st Century Family Cares - MedicaidNJ DirectNJ Direct MA PPONo InsuranceNorthwellOMNIAOMNIA BronzeOMNIA GoldOMNIA HSAOMNIA PlatinumOMNIA SilverOMNIA Silver HSAOptum Behavioral HealthOxfordOxford HealthOxford Health Plan HMOOxford Health Plan PPOOxford Medicare Advantage PlansOxford Medicare Advantage Private Fee For Service PlansPPO Next MasterCarePrime Health ServicesPrivate Healthcare Systems (PHCS)QualcareQualcare HMOQualCare POSQualcare PPOQualCare Workers CompRailroad MedicareState FarmThree Rivers Health PlanThree Rivers Provider NetworkTravelersTricareUHC/OXUHCCPUnited AmericanUnited BehavioralUnited CommunityUnited HealthcareUnited Healthcare Charter BalancedUnited Healthcare Charter HMOUnited Healthcare Charter PlusUnited Healthcare ChoiceUnited Healthcare Choice PlusUnited Healthcare Community PlanUnited Healthcare Community Plan (formerly Americhoice Managed Medicaid)United Healthcare CoreUnited Healthcare Core EssentialUnited Healthcare Core HMOUnited Healthcare NavigateUnited Healthcare Navigate BalancedUnited Healthcare Navigate PlusUnited Healthcare Options PPOUnited Healthcare Oxford FreedomUnited Healthcare Oxford LibertyUnited Healthcare Oxford MetroUnited Healthcare SelectUnited Healthcare Select PlusUnited MedicareUnited Medicare Advantage PlanUnited Medicare Advantage Private Fee For Service Plans (PFFS)United Payors & United ProvidersUnitedHealthcare Assisted Living Plan (HMO SNP)UnitedHealthcare Assisted Living Plan (HMO-POS SNP)UnitedHealthcare Assisted Living Plan (PPO SNP)UnitedHealthcare Group Medicare Advantage (HMO)UnitedHealthcare Group Medicare Advantage (PPO)UnitedHealthcare MedicareComplete Focus (HMO)UnitedHealthcare Nursing Home Plan (HMO SNP)UnitedHealthcare Nursing Home Plan (HMO-POS SNP)UnitedHealthcare Nursing Home Plan (PPO SNP)University Health PlanUS Family Health PlanUS Family Health Plan (Tricare Prime)US Family PlanUSA Managed Care OrganizationValue OptionsVeterans Affairs AdministrationWellCareWellCare Health PlanWellcare Managed Medicaid (Family Care)Wellcare Managed MedicareWellchoiceWellPoint (Amerigroup) *Affiliations Please select all RWJBarnabas Health facilities you are affiliated with: Childrens Hospital of New Jersey at Newark Beth Israel Medical CenterChildrens Specialized HospitalClara Maass Medical CenterCommunity Medical CenterCooperman Barnabas Medical CenterJersey City Medical CenterMonmouth Medical CenterMonmouth Medical Center, Southern CampusNewark Beth Israel Medical CenterRobert Wood Johnson Medical School Robert Wood Johnson University HospitalRWJ University Hospital HamiltonRWJ University Hospital RahwayRWJ University Hospital SomersetRWJBarnabas Health Medical GroupThe Bristol-Myers Squibb Childrens Hospital at RWJUHThe Unterberg Childrens Hospital at Monmouth Medical CenterTrinitas Regional Medical Center Please confirm security question above