Inform us of your practice changes

Choose the appropriate form below

*Alternative medicine providers
Chiropractors, Naturopaths, Massage Therapists and Acupuncturists
**Mental health providers

ONLY if you hold an active contract with Kaiser Permanente to provide outpatient mental health and substance use disorder services to Kaiser members and need to make updates to your practice demographics, please contact Magellan Healthcare at and update your practice information via their online Provider Data Change Form. Refer to your welcome letter from Magellan for your username and password.
All other mental health provider updates (inpatient, IOP, PHP, RTC, TMS, ABA) should use the forms below.

Practice, organization and billing changes

90-day notice is required. If we do not receive notice of your change within the 90-day required period, your change may not be reflected in our systems, including provider directory, claims, prior authorizations, etc.

If you are enrolled in Electronic Funds Transfer you must also notify InstaMed of Billing NPI and Tax ID changes
Phone: 1-877-833-6821

Terming a practitioner

Individual practitioner term form
Term your contract with Kaiser Permanente

Delegated Organizations/Providers:
If your clinic is listed below, please contact your credentialing specialist to make these changes. We will not term the practitioner, as we must follow the standardized process of roster notification.

  • Apple Physical Therapy (ATI)
  • Children's University Medical Group
  • Evergreen Health
  • Franciscan Medical Group/Franciscan Health Systems
  • Ginger IO
  • Harborview Medical Center
  • Kadlec Regional Medical Center
  • Kootenai Health
  • Magellan**
  • MATRIX Medical Network
  • Memorial Physicians, PLLC (dba Yakima Valley Memorial Hospital)
  • MultiCare Health System
  • Northwest Rehab Alliance (NWRA)
  • PacMed Clinics
  • PeaceHealth Medical Group
  • Polyclinic
  • Proliance Surgeons
  • Providence Health & Services – Washington
  • Skagit Regional Clinics/Skagit Valley Hospital
  • St. Luke's Rehab Institute
  • Swedish Health Services
  • The Everett Clinic [TEC]
  • Tivity / WholeHealth Networks, Inc.*
  • University of Washington Physicians
  • Valley Medical Center
  • Virginia Mason Medical Center
  • Walla Walla Clinic
  • Western Washington Medical Group
  • Yakima Valley Farm Workers

Adding an individual practitioner

Individual practitioner add form
Active contracts only

If you do not know if you are directly contracted with Kaiser Permanente, please reach out to your organization’s contracting department. Unsolicited requests may be declined if there is no business need.

We have limited needs within our network for new contracts. Please review the following page: Contracting with Kaiser Permanente