Completing this form is not necessary if the provider currently has a Rhode Island Medicaid number. Individual providers, new groups and new providers joining an established group should submit documentation according to the requirements outlined in each link below:
RIte Share - Individual Provider Enrollment Form
RIte Share - New Group Provider Enrollment Form
RIte Share - New Provider Joining an Established Group
In addition to the application form above, please submit:
Additional Forms
Authorization for Direct Deposit (Mandatory)