Enroll Practice

NPI*Required

Start with the NPI and we will see if we can find the rest.

Practice

Please input the name and location of your practice. (* are required)

Please Enter Practice Name
Please Enter Practice Phone Number
Please Enter Practice Fax Number
Please Enter Practice Address
Please Enter Practice City
Please Select a State
Please Enter Practice Zip
Practice Contact

Please input your user information. (* are required)

Please Enter Contact First Name
Please Enter Contact Last Name
Please Enter Contact Email Address
Physician

Adding an email address for a physician will enroll the physician as a user.

Please Enter Physician First Name
Please Enter Physician Last Name
Please Enter Physician NPI
Please Enter Physician Fax Number
Please Enter Physician Phone Number
Please Enter Physician Email Address
No results have been found for this NPI. Please try again