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Enter NPI # for Physician or Mid-Level Provider
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ACO Registration


Registration Instructions


Please complete the following information about your practice and physicians. After review of your registration, signed agreements will be sent to the e-mail address provided below.


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PROVIDER GROUP INFORMATION



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PRACTICE INFORMATION


Address/Tax
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Primary Contact
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PHYSICIAN INFORMATION


Click ADD to enter physicians
Physician NPI # Physician Name Physician Specialty Physician Contracts PhysicianContractsID PhysicianSpecialtyID ProviderExists RegistratinPhysicianID Select

DOCUMENT UPLOAD


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    REGISTRATION COMPLETION



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    Please enter representative name who assisted with this application.

    Please review the following information and click the Submit button below. Your information will be review and approved. You will be notified by email, when your submission has been approved.

    Provider NPI Provider Name Add to Provider Group/Contracts