Important: If you are registering as a provider, enter the provider's first and last name, or split the facility or organization name across the first and last names. If you have chosen to register as a delegate, you must have already provided your birth date and driver's license number (DLN) to a registered provider, who will add you as a delegate and obtain the delegate code for you.
If you have chosen to register as a Trading Partner, enter the Trading Partner ID.
If you have chosen to register as a Managed Care Org, enter the NPI/Provider ID and Zip Code.