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Address Change

Required fields are marked with an asterisk (*)

(numbers only/without dash)
NPI must be 10 numbers

Billing Address

(numbers only/without dashes)

Update Requested By

(numbers only/without dashes)
NPI must be 10 numbers.
(numbers only/without dash)

Please use the “Add an Additional Location” option if this is a brand new location.

Practitioner Name

Enter N/A if uploading a list of practitioners.
Enter N/A if uploading a list of practitioners.
Enter N/A if uploading a list of practitioners.
NPI must be 10 numbers. Enter 9999999999 if not available.
For multiple practitioners at the same location, please upload an Excel spreadsheet with names and NPI numbers for each practitioner.

Old Location Address

Enter N/A if not available.

New Location Address

Primary Location
Enter N/A if not available.

Update Requested By

(numbers only/without dashes)
(numbers only/without dash)
NPI must be 10 numbers long.
Enter N/A if not available.
(numbers only/without dashes)
(numbers only/without dashes)

Member Access

Location Hours

Please specify if Closed, Open 24 hours, or Enter hours in 15 minute increments, ex. 9:15 AM.

Language Services

Electronic Health Records

Location Accessibility

Buckeye Health Plan is committed to providing equal access to quality health care and services that are physically and programmatically accessible for our members with disabilities and their companions. Buckeye aims to transition health-care delivery into a fully accessible system for our members, while improving the accuracy and transparency of disability access data in Buckeye’s provider directories. Members are able to view a location’s detailed disability access information using the online Find a Provider tool, as well as filter for a provider based on their disability access needs. 

Access Survey

(numbers only/without dash)
NPI must be 10 numbers long.

Delete Location Address

Enter N/A if not available.
(numbers only/without dashes)

Update Requested By

(numbers only/without dashes)