network membership

Once the Centers for Medicare & Medicaid Services (CMS) issue a Medicare Provider Number to the facility, a copy of the official certification letter is sent to the Network. Facilities may also fax a copy of the letter they receive to the Network at 804.320.5918.

Facilities may initiate a Membership Agreement below, with information from the certification letter. The online membership agreement is validated and executed immediately; you may download or print your agreement during this process.  Facility should maintain executed agreement on-site.

Opening a new ESRD Facility in Virginia, West Virginia, Maryland, or District of Columbia


Prior to CMS Certification

  1. Complete and submit this form  
  2. Print confirmation for the State Surveyor visit

Initiate Membership Agreement

After CMS Certification

  1. Your facility will receive a letter from the State Survey Department containing your facility’s CMS Certification Number (CCN). 
  2. Obtain access to the following national data systems:
  3. Hang Network 5 Grievance Posters (English or Spanish) in area visible by patients. Facilities can order more by contacting the Network office at

Important Resources

Conditions for Coverage

Interpretive Guidelines


Involuntary Transfers & Discharges

Emergency Preparedness

Network 5 Staff

Email Alison Crittenden at the Network office at or call Alison at 804-320-0004, Ext. 2707, with any questions.