This window allows you to indicate whether you are registering as a new administrator for an existing provider identification number, or as a new location for the provider.
You must have already successfully passed authentication for provider registration before this page will be displayed.
A Provider Business may have no more than 2 active administrators at any one time.
Additional locations for a provider identification number, after the initial registration, will be registered in the Other Business category and must request authorization from the provider.
Field Name |
Definition |
Validation Rules |
Field Type |
|
Option I |
indicates you are registering as a new location for the provider |
Either Option I or Option II must be selected. |
|
|
Option II |
indicates you are registering as a second administrator for the provider name and address displayed |
Either Option I or Option II must be selected. |
|
|
Name and Address |
the provider's name and address |
N/A |
Display Only |