Let's start by creating your secure account and gathering some basic information for your organization profile.
NPI Number
Enter your NPI and click Verify to auto-fill your organization name, specialty, state, and taxonomy code.
Kind of Organization *
Enrolls with Medicare on form CMS-855B (group / supplier).
Legal Structure
Primary State of Practice *
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Select a state of practice...
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Alabama
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Alaska
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American Samoa
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Arizona
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Arkansas
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California
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Colorado
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Connecticut
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Delaware
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District of Columbia
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Federated States of Micronesia
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Florida
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Georgia
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Guam
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Hawaii
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Idaho
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Illinois
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Indiana
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Iowa
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Kansas
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Kentucky
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Louisiana
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Maine
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Marshall Islands
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Maryland
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Massachusetts
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Michigan
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Minnesota
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Mississippi
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Missouri
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Montana
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Nebraska
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Nevada
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New Hampshire
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New Jersey
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New Mexico
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New York
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North Carolina
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North Dakota
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Northern Mariana Islands
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Ohio
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Oklahoma
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Oregon
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Palau
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Pennsylvania
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Puerto Rico
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Rhode Island
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South Carolina
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South Dakota
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Tennessee
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Texas
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Utah
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Vermont
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Virgin Islands
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Virginia
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Washington
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West Virginia
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Wisconsin
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Wyoming
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Legal Business Name
Exactly as on your IRS CP-575 letter.
Password *
Must be at least 8 characters.