Registrant Information - CCP Portal e-Apply website

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Are you the Site Manager?

The Site Manager must be the first user in your group to complete the online form. As a reminder:

Typically, the Office Manager or Administrator functions in this role
Each group requesting access must designate a Site Manager
To review the Site Manager responsibilities, see section, “Important Information,” subsection, "Site Managers"

If you are not the Lead Site Manager, please ask your office manager/administrator to provide you with the Application Key they received upon completing their application and enter it below to start your application.

The Application Key will link your application to your Site Manager and any other portal users in your group.

If your Site Manager cannot find the Application Key, please advise them to contact us via email at PlanLink@ccpcares.org for assistance.

If your Site Manager has not yet applied for PlanLink access, forward them the following link https://e-apply.ccpcares.org

Practice/Vendor Name

Sponsor’s Full Legal Name

Sponsor’s email

Sponsor’s Title

Group/ Facility Tax ID (No dashes or spaces)

Group/Facility NPI

Legal First Name

Legal Last Name

Title

Office Phone Number

Office Email Address

Check here if the physicians in your practice are clinically credentialed (i.e. on staff) with Memorial Healthcare System located in Broward County, Florida.

Community Care Plan cannot process your request for provider portal access. Please contact the MHS IT Services Desk at 954-276-4848 for more information.

Please indicate the providers at your practice who are contracted with a Community Care Plan administered health plan. If the list of providers is large, you may email this list to CCP at PlanLink@ccpcares.org

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Group/ Facility Information

Lead Site Manager Information

Physician Information

Providers at Your Practice