Medicaid Enrolled Provider Listing

Revalidation disclaimer: The next anticipated revalidation date is an estimated date that may be subject to change based on factors such as a timing lag, updates made to an enrollment file prior to revalidation, and the State’s ability to extend the date for certain providers. Therefore, providers should make sure the correspondence address on their enrollment file is current, and providers should not submit a revalidation package until they receive a notice in the mail to do so. The notice will contain the deadline for submitting the revalidation.

This is a list of active Medicaid fee-for-service (FFS), Managed Care Only and Ordering, Prescribing, Referring, Attending (OPRA) providers. Data elements include the provider’s Medicaid Provider ID, NPI, provider or facility name, Medicaid type, profession or service, provider specialty, service address, city, state, zip code, county, telephone number, latitude, longitude, enrollment begin date, next anticipated revalidation date, date the file was extracted from the data warehouse and a Medically Fragile Children and Adults Directory Indicator.