*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	AARP 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)
Aetna	Aetna Better Health
Aetna Choice POS II	Aetna Dental
Aetna Elect Choice	Aetna EPO
Aetna First Health	Aetna Health Plans of NJ
Aetna HMO	Aetna Indemnity plans with network incentives
Aetna Joint Claims Administration	Aetna Managed Choice POS
Aetna Medicare	Aetna Medicare NNJ Prime
Aetna Medicare Plan (HMO)	Aetna Medicare Plan (PPO with Extended Service)
Aetna Medicare Plan (PPO)	Aetna Meritain/Meritain Shared Administrative Services
Aetna Open Choice	Aetna Passport to Healthcare®and National Advantage
Aetna Passport to Healthcare®and National Advantage Program	Aetna POS
Aetna PPO	Aetna QPOS
Aetna Select	Aetna Signature administrators®
Aetna Student Health	Aetna US Health Care
American Postal Workers Union	America's Health Plan
Americhoice	Amerigroup
Amerigroup (Managed Medicaid Plan)	Amerihealth
Anthem Health	Anthem Health of NY
Bankers Life and Casualty	Beacon
Beech Street	BeechStreet PPO
Benefit Planners Insurance	Benesight
Blue Cross Blue Shield Omnia	Blue Cross/Blue Shield NJ
Braven Health	Centivo
Charity Care Accepted	CHN
Cigna	Cigna Behavioral Health
Cigna Health Springs	Cigna Healthcare
Cigna Healthcare of New Jersey – Northern NJ HMO	Cigna Healthcare/Great West
Cigna HMO	Cigna Medicare
Cigna Open Access Plus, Choicefund OA Plus	Cigna Open Access Plus, OA Plus, Choicefund OA Plus with CareLink
Cigna PPO, Choicefund PPO	Cigna Seamless – Metro New York
Clover	Clover Health
Community Care Network	Consumer Health Plan
Coventry	Delta Dental
Devon Health Services	DOL
Emblem	Emblem Health / GHI
Emblem Health / QualCare	Empire BC/BS
Empire Healthchoice	Empire through Blue Card Program
Erickson 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 Systems
Family Choice Health Alliance	Federal Blue Cross PPO
Fidelis (WellCare)	First Health Network
First Managed Care Option	First MCO (Worker's Comp)
First MCO/Active Care	Focus Healthcare
Galaxy Health Care	Galaxy Health Network
Genworth	GHI
GHI PPO	GHI through QualCare (only for patients where the Qualcare logo appears on ID card)
Great West Healthcare	Great-West (Cigna)
Guardian Resources Inc.	Health Net
Health Network America Inc.	Health New Federal Services
Health Republic Insurance of NJ	Healthcare Payers Coalition
Healthcare Payors Organization	Healthfirst of New Jersey
HealthNet Federal Health Services (TriCare-Champus)	HIP PPO
HMO Blue - Medicare Blue	Horizon
Horizon Advantage EPO	Horizon BCBS
Horizon Blue Cross Blue Shield HMO	Horizon Blue Cross Blue Shield Indemnity
Horizon Blue Cross Blue Shield Medicare Blue	Horizon Blue Cross Blue Shield of NJ
Horizon Blue Cross Blue Shield Omnia	Horizon Blue Cross Blue Shield PPO
Horizon Casualty	Horizon Casualty Services (Worker's Comp & No Fault)
Horizon Direct Access	Horizon EPO/EPO Plus
Horizon HMO	Horizon Managed Care
Horizon 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 Access	Horizon MyWay HRA PPO
Horizon MyWay HSA Direct Access	Horizon MyWay HSA PPO
Horizon NJ Health	Horizon NJ Health (managed Medicaid plan)
Horizon Patient-Centered Adv EPO	Horizon POS
Horizon PPO	Horizon Traditional/Indemnity
Humana Medicare	Humana Tricare
Independence BCBS	Intergroup Services
Liberty Mutual	Local 1199
Local 464/Maxon	Local 734
Local 825 Welfare Fund	Longevity
Lutheran Senior Healthcare	Magellan
Magellan Behavioral Health	Magnacare
Magnacare/Magnet	Mail Handlers Benefit Plan
Managed Health Network	MCS Patient Centered Health Care Network
Medicaid	Medicare
Metlife	Multiplan
Multiplan / PHCS	Multiplan/Beechstreet/PHCS/Viant
Multiplan/PHCS Savility	Mutual of Omaha
National Association of Letter Carriers	National Health Plan
National Preferred Provider Network (NPPN)/Plan Care America	National Provider Network
New Jersey Carpenters Health Fund	New Jersey Manufacturers
New Jersey Manufacturers through Horizon Casualty	New Jersey Plus
NJ 21st Century Family Cares - Medicaid	NJ Direct
NJ Direct MA PPO	No Insurance
Northwell	OMNIA
OMNIA Bronze	OMNIA Gold
OMNIA HSA	OMNIA Platinum
OMNIA Silver	OMNIA Silver HSA
Optum Behavioral Health	Oxford
Oxford Health	Oxford Health Plan HMO
Oxford Health Plan PPO	Oxford Medicare Advantage Plans
Oxford Medicare Advantage Private Fee For Service Plans	PPO Next MasterCare
Prime Health Services	Private Healthcare Systems (PHCS)
Qualcare	Qualcare HMO
QualCare POS	Qualcare PPO
QualCare Workers Comp	Railroad Medicare
State Farm	Three Rivers Health Plan
Three Rivers Provider Network	Travelers
Tricare	UHC/OX
UHCCP	United American
United Behavioral	United Community
United Healthcare	United Healthcare Charter Balanced
United Healthcare Charter HMO	United Healthcare Charter Plus
United Healthcare Choice	United Healthcare Choice Plus
United Healthcare Community Plan	United Healthcare Community Plan (formerly Americhoice Managed Medicaid)
United Healthcare Core	United Healthcare Core Essential
United Healthcare Core HMO	United Healthcare Navigate
United Healthcare Navigate Balanced	United Healthcare Navigate Plus
United Healthcare Options PPO	United Healthcare Oxford Freedom
United Healthcare Oxford Liberty	United Healthcare Oxford Metro
United Healthcare Select	United Healthcare Select Plus
United Medicare	United Medicare Advantage Plan
United Medicare Advantage Private Fee For Service Plans (PFFS)	United Payors & United Providers
UnitedHealthcare 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 Plan
US Family Health Plan	US Family Health Plan (Tricare Prime)
US Family Plan	USA Managed Care Organization
Value Options	Veterans Affairs Administration
WellCare	WellCare Health Plan
Wellcare Managed Medicaid (Family Care)	Wellcare Managed Medicare
Wellchoice	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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