New Provider Form

In order to ensure that your providers are added as qualified participants of the ACO and get access to all the services and tools provided by WKCC, please fill out this form:

National Provider Identifier
Council for Affordable Quality Healthcare Identification
Users are advised that the information submitted through this form may be transmitted over unsecured email and releases WakeMed and its employees, agents, and subcontractors from all responsibility or liability for any claims or damages arising from the content of the Email Form or the transmission thereof. By selecting the "I agree to Terms and Conditions" checkbox user acknowledges these terms and conditions and consents to transmission of the form. Plus, by completing this form, I am agreeing to receive relevant health information from WakeMed. I understand I can opt-out from these communications at any time.
Portal Access