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Healthcare Provider Assessment

Who needs to fill out a Healthcare Provider Assessment?

In addition to population data, an important piece to shortage designation is healthcare provider information.

HRSA requires that the Primary Care Offices regularly evaluate (now annually or at least every 24 months) all primary care, mental health, and dental health providers to assess whether there is adequate primary medical, dental, or mental health care available statewide. To do so, the NV PCO contacts healthcare facilities and providers, primarily by phone or surveys to conduct the evaluation on an ongoing basis. The NV PCO relies on timely and accurate responses to make clear determinations about whether or not an area would qualify for a shortage designation.

Help us! If you are a primary care provider, psychiatrist, dentist or an administrator who works with these types of providers, please complete a Healthcare Provider Assessment form to submit updated provider/practice information. The Healthcare Provider Assessment fillable PDF form should take approximately 5-10 minutes to complete and can be submitted to us via email at (Note – the form can also be printed and completed by hand prior to emailing)

Have you or a provider you worked with moved to a different location? Retired? Working more hours? Working fewer hours? Let us know so we can better understand the primary care, mental and dental health access for your community!

The detailed information provided (non-publicly available information will not be distributed or shared to any other entities unless de-identified and compiled in aggregated data); and will be used to evaluate and/or apply for a HPSA designation.

Who needs to fill out a Healthcare Provider Assessment?

  • Primary Care Physicians (MD or DO)
    • Family/General Practice
    • Internal Medicine
    • OB/GYN
    • Pediatrics
  • Psychiatrists (MD or DO)
  • Dentists (DDS or DMD)
    • General Dentistry
    • Pediatric Dentistry

Note: Please complete a separate assessment for each healthcare provider in your office. If a provider practices at multiple locations, please fill out a separate assessment for each additional location.




    Contact Us

    4150 Technology Way, Suite 300
    Carson City. NV 89706

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