CCPHO Process & Application

The CCPHO values the contractual relationships it has developed with participating payer organizations. In order for a provider/physician (MDs, DOs, & DPMs only) to become a member of the CCPHO, they must first hold some type of privilege with Fawcett Memorial Hospital. (For more information please contact Denise MacKenzie with Fawcett's Medical Staff Office at (941) 624-8072 or email denise.mackenzie@hcahealthcare.com)

By contracting with the CCPHO via our Provider Participation Agreement, the CCPHO is able to offer payers, via the messenger process, an extensive network of credentialed providers, and offer participating physicians a simplified contracting process.

Additional agreements are constantly being explored. Each physician who chooses to use the CCPHO may elect to work with any or all of these payer agreements or to establish their own independent agreements.

Thank you for your interest in the Charlotte County Physician Hospital Organization (CCPHO). Please review the CCPHO's Bylaws to understand the CCPHO's organizational structure and authority, the Provider Participation Agreement to understand your obligations as a participating physician.
Download and complete the application form below. Please ensure that all areas and signatures are complete, and submit the required documents and membership dues, via one of the options below:

Mail:

CCPHO
P.O. Box 494134
Port Charlotte, FL 33949

OR:
EMAIL all documents:
director@ccmsdoctors.com

OR:
FAX all documents:
1-888-739-7861

If you have any questions about the application process, please call Danielle Brightman at (941) 391-1179.

Please download all required forms below in the Download section below.