Professional Provider Membership

Below you can enter your program information, staff contacts information and pay securely using a credit card. If you prefer to pay by check, you can download the PDF membership packet HERE, complete the forms and submit with payment by US Mail to OHPCA at P. O. Box 592, Marylhurst, OR 97036.

  • PROFESSIONAL PROVIDER MEMBER DUES

    Professional Provider Members are corporations, agencies, or divisions who provide hospice and/or palliative care under a single CMS Provider Identification Number (Including identified multiple locations). Dues Calculation: flat fee of $400 + $5.50 per patient admission for year 2023. All fields with a red asterisk are required. Questions? Please email Meg at mccauley@oregonhospice.org or call/text 503.890.7027.
  • Provider Member Program Details

    Information in this section reflects what will appear on your listing in OHPCA's website Directory.
  • Please enter your Program Name as you'd like it to appear on the OHPCA website directory.
  • Please enter your Program Address as you'd like it to appear on the OHPCA website directory.
  • Please enter your Program Telephone Number as you'd like it to appear on the OHPCA website directory.
  • Please list up to 15 main cities/areas your Program serves so consumers can search the OHPCA website directory by City and find your program.
  • Please list the counties your Program serves so consumers can search the OHPCA website directory by County and find your program.
  • Staff Contacts

    Please include program staff information so that we can add them to our monthly networking distribution lists.
  • Please include the contact information for the person who should be listing on your program's directory listing on the OHPCA website.
  • If you do not have someone in this role at this time, please insert Program Director name.
  • If you do not have someone in this role at this time, please insert Program Director email.
  • To add more staff to our distribution lists, please email mccauley@oregonhospice.org with the names, titles, email addresses and which networking lists they would like to be added to.
  • Payment Information

    All major credit cards accepted for payment. If you're paying by check, please complete and mail your payment using the Spring Intensive Packet PDF link above in the conference information section.
  • Please include the email address of the person who will receive this receipt of payment.
  • Price: $5.50
    $5.50 per patient admissions in 2023
  • $0.00