Create your provider account

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Account details

Use your name and the email address you’ll sign in with.

First name

Last name

Email address

Phone number

Password

At least 8 characters. Use a unique password for your account.

These details help us with credentialing and prescribing setup.

Practice name

Just getting started? Use your name for now. You can change this later.

Practice state

Individual NPI (optional)

Ten digits. You can add it later.

Date of birth

Used for payer verification.

Administrative gender

Required by the prescribing network.

Payer applications require your personal address, even if your practice is elsewhere.

Street address

City

Home state

ZIP code

Review the Business Associate Agreement below, then add your signature to create your account.

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Scroll or use your keyboard to read to the end before signing.

Full legal name for your signature

Typing your name serves as your electronic signature.

I have read and agree to the Business Associate Agreement.

For information about how we use your details, read our Privacy Policy (opens in a new tab).

Your account is created only when you sign and submit.