Provider Enrollment Applications Provider Type: Select Provider Type 21st Century Cures Act Adult Day Health Services Adult Mental Health Rehab Advanced Practice Nurse - Group Advanced Practice Nurse - Individual Applied Behavior Analysis (ABA) Treatment Providers Applied Behavior Analysis (ABA) Treatment Providers - Addendum Assisted Living Board Certified Behavior Analyst (BCBA) Individual Provider Chiropractor - Group Chiropractor - Individual Community Suppport Services DDD Dentist - Group Dentist - Individual Diagnostic Facility/MRI Dispensing Optician Doula Doula - Addendum Doula - Group End-Stage Renal Dialysis Hearing Aid Dealer Home Health Agency/Personal Care Assistant/Private Duty Nursing Hospice (ACCAP) Hospital Independent Clinic - Ambulatory Care Independent Clinic - Ambulatory Surgi-Center Independent Clinic - Cerebral Palsy Independent Clinic - Dental Independent Clinic - EPSDT Independent Clinic - Family Planning Independent Clinic - FQHC Independent Clinic - Mental Health Independent Clinic - Narcotic & Drug Abuse Independent Laboratory Intermediate Care Facility (ICF/IID) Lead Screening Medical Supply - DME Midwife-Group Midwife-Individual Navigator - Addendum Non-Billing Provider (FD20B) Nursing Facility (LTC) One-page Group Provider Linking (FD-23A) Optometrist - Group Optometrist - Individual PACT Peer - Addendum Pharmacy Pharmacy - Change Store Location Physician - Group Physician - Individual Podiatrist - Group Podiatrist - Individual Portable X-Ray Prevention Agency Prosthetic and Orthotic Providers of Developmental, Individual Difference, Relationship-Based Models of Intervention (DIR) Psychiatric Hospital Psychologist - Group Psychologist - Individual Residential Treatment Center Special Education Medicaid Initiative SUD Care Manager Addendum Workfirst