Common Contracts

North Shore-LIJ Clinical Integration IPA (CIIPA) Provider Participation Agreement

Participation Agreement • August 10th, 2011 • New York

• Contract Type
  Participation Agreement
• Filed
  August 10th, 2011
• Jurisdiction
  New York

This IPA Provider Participation Agreement (“Agreement”), made effective as of Provider’s Enrollment Date as specified on the CIIPA on-line Enrollment Completion Notification (“Effective Date”) by and between North Shore- LIJ Network, Inc. and its related IPA North Shore-LIJ Clinical Integration Network IPA, LLC (the entities collectively shall be referred to as the “IPA”), located at 145 Community Drive, Great Neck, New York 11021, and IPA Participating Provider (“Provider”). Provider and IPA together shall be referred to as “Parties.”