Clinician Information for Diversity and Health Equity

Clinician Diversity and Inclusion

HealthPartners is committed to supporting diversity and inclusion in our communities to improve health care equity. As part of this effort, we are collecting clinicians’ race, ethnicity, and cultural information. Providing this information is completely voluntary, and, with your approval, the information will be available in the provider directory on HealthPartners.com.

We recognize this data can be sensitive; therefore you may choose to exclude this information from the directory if you DO NOT want your race, ethnicity, and country of origin to be visible through the HealthPartners.com provider directory.

Practitioner Information (name as appears on license)

First Name

Last Name

Individual Identifier

Individual (type 1) NPI

UMPI (if no NPI)

Social Security Number

NPI

UMPI

Last 4 Digits of SSN

identifiertextbox

Email Address (for questions on information provided)

We will contact you through the email address provided if there are questions regarding any information provided.

All of the following sections are optional.

Community competency categories selected should reflect experience and/or training in providing care to support those patients’ values, beliefs, attitudes and experiences.

Language (can select more than one)

Other Language

Ethnicity (select one)

Hispanic or Latino

Not Hispanic or Latino

Choose Not to Answer

Race (can select more than one)

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other, please specify below

Choose not to answer

Please specify your race association:

Country of Origin (select one)

Please specify your Country of Origin

Exclude Ethnicity, Race and Country of Origin from Directory

Yes, exclude my information