External Provider Trust

New Users

User Information

Approve User

User Information

Return to Grid

Registration Information

Organization

Organization name:

Address 1:

Address 2:

City:

State:

Zip code:

Phone number:

Primary NPI:

Primary TIN:

User

First name:

Last name:

Job title:

Email:

Phone number:

Functionalities

NPI assignment

Available Current

TIN assignment

Available Current