Nominate a Provider

If you would like to nominate a provider to join American Specialty Health Networks (ASH Networks) please complete the information below. All nominated providers are sent credentialing materials and invited to join ASH Networks. Once ASH Networks receives completed credentialing materials, the credentialing process will take approximately 60-90 days to complete. If a provider is approved to participate, ASH Networks will notify them with welcome materials and specific information regarding participation. Providers that are approved for network participation are activated immediately once credentialing is completed.

Provider Information
Name:
May we share your name with the provider?

*ChooseHealthy will only share your name with the provider if you give us authorization to do so. View our Privacy & Security policy.

Providers First Name:*
Providers Last Name:*
Clinic/Facility Name:
Provider Specialty:*
Phone:*
(###-###-####)

Provider Address
Street:*
City:*
State:*
Zip Code:*