Provider Directory Information Verification or Change Form


Use this form to verify that your information in HPSM's provider directory is correct, or to submit a change to your directory information.

To begin, please enter your NPI number below:

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If you've reviewed all information and confirm that no changes, corrections, or modifications are necessary to what Health Plan of San Mateo has on file please click here:
I confirm that office staff are aware of the provider's contract listed above:

For other questions or comments related to this form please contact provider services at 650-616-2106.
Please provide your contact information below in case we need to contact you regarding your request.
You will receive a confirmation page and acknowledgement of receipt by email after clicking submit.