HPC PCMH Certification

As of January 1, 2019, any Massachusetts practice that achieves NCQA Distinction in Behavioral Health Integration may be granted HPC PCMH Certification. Please fill out the fields below to request HPC PCMH Certification for your practice.

Contact Information

Primary contact at the practice*

First Name

Last Name

Email address for primary contact*

Phone for primary contact*

Practice Information

Practice Name*

Practice Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Practice size*

1-5 primary care clinicians 6-20 primary care clinicians 21-50 primary care clinicians 51-100 primary care clinicians 100+ primary care clinicians

"Primary care clinicians" refers to providers holding a current, unrestricted license as a doctor of medicine (MD), doctor of osteopathy (DO), APRN (including nurse practitioners, clinical nurse specialists) or a physician assistant (PA) who practices internal medicine, family medicine or pediatrics, with the intention of serving as the personal clinician.

Was the practice previously on the Pathway to PCMH PRIME or certified as a PCMH PRIME practice?*

Yes No

If the practice name has changed, please provide the practice name at the time it achieved Pathway or PRIME status.

Please provide the date the practice achieved NCQA Distinction in Behavioral Health Integration.*