Interested in becoming a Greater Mankato Health Plan provider?

Greater Mankato Health Plan contracts with physicians and providers to provide services to our members residing in SW Minnesota.

If you are interested in participating in our provider network, please fill out the form below and a Greater Mankato Health Plan representative will contact you once the request has been reviewed. The review process could take up to 30 days, depending on scheduling.

If you do not receive a response after 30 days, please email cwilwert@mahealthcare.com to request an update on your inquiry.

Facility or Office Name

Practitioner First and Last Name

Title/Degree

Hospital/Surgery Center Affiliations

Contact Person

Phone

Address

Address Line 2

City/State/Zip

Additional Practice Locations

Primary Specialty

Secondary Specialty

Practice Status

Full-time Part-time PRN Locum

Telehealth ONLY

Yes No

Participating in Medicare

Yes No

List Board Certifications, Board Eligible, or Not Applicable

Effective Date

NPI#

Tax ID#

CAQH ID#

Other Information