NC*Notify Online Enrollment (CCNC) Indicates required field This enrollment form is intended only for practices that are part of the Community Care Physicians Network that are designating Community Care of North Carolina (CCNC) as the responsible party for managing their NC*Notify feeds. To learn more about other options and upgraded features available through NC*Notify, please send an email to firstname.lastname@example.org. Organization Information Organization Name Organization Address Address 2 City State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code Organization Phone Number Organization Type (Select all that apply.) Hospital Primary Care Free Clinic Community Health Center/FQHC Behavioral Health Specialist Other Other Organization Type Status message Please be sure to select at least one option above before continuing. Organization NPI (Separate multiple NPIs by a comma.) Medicaid Region (Select all that apply.) Region 1 Region 2 Region 3 Region 4 Region 5 Region 6 Status message Please be sure to select at least one option above before continuing.