ACCESSING A KASIER PERMANENTE SPECIALIST:
In order to treat with a Kaiser Permanente Specialist, the injured worker must first be evaluated by a Kaiser Permanente On-the-job (KPOJ) Occupational Medicine physician. The KPOJ physician will determine the appropriate Specialist, make the referral and clinic staff will assist to schedule the referral and appointment with the specialist within the MPN. To schedule an initial appointment with a KPOJ physician, call the preferred KPOJ clinic location phone number included in the MPN listing. You may also contact the MPN Medical Access Assistant line listed below for additional assistance.

Your Information *

Name*

Phone*

E-mail*

Title

Preferred method of contact?

Email

Phone

Postal-mail

Provider Type *

Medical Group

   

Specialty

Sub-specialty

Physician

   

Specialty

Sub-specialty

DME

ASC

Group Name / DBA

 

Physician Information

First*

Middle*

Last*

Credential*

   

State License Number*

Tax ID Number*

NPI Number*

DEA Number

Effective Date

Physician Locations

Address*

City*

State*

Zip Code*

Tax ID*

Phone*

Fax

Website

Billing Addresses

Address*

City*

State*

Zip Code*

Phone

Fax

Office Manager Contact Information

Name*

Phone*

E-mail*

Fax

Previously Nominated?

If Yes, when?

Referred by anyone?

• If Yes, referred by:

Name

Phone

Title

   
 
Please allow 6-8 weeks for your nomination to be processed and for contractual material to be issued.
* Denotes Required Field
 

 

To Nominate a Provider: Click Here.

To Report Inaccuracies in provider data: Click Here, email ProviderUpdate04@snp-plus.com, or call 562.546.0035.
 

The contact information for the Medical Access Assistant is:   The contact for your MPN is:
     
Toll Free Telephone Number: (877)287-4782   Name: Tristar Risk Management
Fax Number: (925)349-7631   Telephone Number: (877)287-4782
Email Address: TRISTARPlusMPN@tristargroup.net    

To obtain a copy of any required MPN notifications, please call (877)287-4782

Date of Last Physician and Provider Listing Update: 2020-06-15 14:48:55