SimpleCare Provider Signup

First Name

Last Name

Suffix

Degree(s)

Gender

Specialties

Select up to three specialties.

Specialty 1

Specialty 2

Specialty 3

Social Media

Facebook

Twitter

Practice Name

Address 1

Address 2

City

State

Zip

Office Phone

Toll Free

Website

Office Hours

Additional Practice Information

Contact Information

Administrator Name

Address

Address 2

City

State

Zip

Contact Phone

Mobile Phone

Fax

Email
We do not share or sell your email address, learn more.

SimpleCare

Provider Membership
$125
Membership Expiration:

Name

Address

City

State

Zip

We gladly accept Visa, Master Card, Discover, and American Express.

Credit Cards

Card Number

Expiration Month

Expiration Year

CVV2

If you have a referral code, enter it here.

Referral Code

User Resources

American Health Value
Children's Cancer
ID Foundation
Metagenics
AirLifeLine
More Resources

Find Us on Social Media

Website Links

Info for Providers
Info for Patients
Info for Businesses
Terms of Use
Privacy Policy
Account Login

Simple Care is not insurance or a discount medical program.

Members in the American Association of Patients and Providers, and its program SimpleCare, are not exempt from the individual mandate in the Patient Protection and Affordable Care Act found in 26 United States Code §5000A(d)(2)(B). SimpleCare is not available in Nevada. SimpleCare is not insurance. It is a not-for-profit organization and is not guaranteed in any way. SimpleCare is exempt from insurance regulation. Click to view our privacy policy

Website Design by Blaser Consulting

SimpleCare Provider Signup

Provider Information

Specialties

Social Media

Practice Information

Contact Information

Billing Information

SimpleCare

User Resources

Find Us on Social Media

Website Links