Join NCIPA
Northern Colorado IPA welcomes physicians and allied health care providers
(Physical Therapists, Speech Therapists, Occupational Therapists, Nurse Practitioners and Licensed Professional Counselors) to join the IPA.
Please contact the IPA office at (970) 495-0333 for questions regarding membership criteria.

To Apply
		Complete and save the Colorado Universal Credentialing Application, or you may use your current completed copy. (Please make sure to include current required documents found on page 3 of the application.)
	Print and fill out these additional forms:
		Business Associate Agreement
		Practice Information
		Insurance Release
		Malpractice Questionnaire
		Insurance Contracts for Primary Care & Specialists
		Insurance Contracts for Therapists
		Insurance Contracts for Therapists
		W-9
		Send Peer Review forms to reference providers for completion. (2 peer reviews are required per provider.)Fee For Service Agreement – Please Call NCIPA Office for Password

Return Application and additional forms to:  Northern Colorado IPA, 1175 58th Ave., Suite 202, Greeley, CO 80634; Fax: 970-224-9624;