MVP Select Care - Members - Change/Select PCP

Primary Care Physician
Change Form

You can change your Primary Care Physician for yourself or your family by filling out the form below. Changes will be effective the date MVP Select Care receives your e-mail. MVP will send you confirmation of receipt of this change form.

Please note: You must contact the new Primary Care Physician to ensure acceptance as a new patient prior to contacting MVP.

You can use MVP's online physician directory to find the address of the Primary Care Physician requested below, or contact us by e-mail to request a current Provider Listing.

Please be aware that only the Subscriber can make a Primary Care Physician change. If making a change for a family member, please enter the Subscriber's ID# along with the family member's ID# or choose "Change all family members" if this applies.

Subscriber ID #:

Social Security #:

First Name (of member for PCP change):

MI:

Last Name:

Member ID #:

E-mail Address * :

New Primary Care Physician:

Reason(s) for change:

Other:

Change all family members?

Please select your preference for confirmation of receipt of information.
Via E-mail
Via Regular Mail

* = This field is required to submit the form.

If you would prefer to contact us by telephone, you can reach our MVP Select Care Service Department toll-free at 1-888-993-0125.

Or, if you are covered through one of the following employers, please call the service number listed below:

Albany Medical Center plan participants: 1-800-361-4334

IBM plan participants: 1-800-765-3773

Price Chopper plan participants: 1-800-586-5386

You may also write to us at:
MVP Select Care
P.O. Box 1434
Schenectady, NY 12301-1434

Back to top