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New User Registration

*Required

* E-Mail :

We recommend using your email address with out the domain
name,i.e user@yourdomain.com would be user.The user name
field will automatically be populated with the first part of
your email address,but may be changed at any time.

* User Name :

* Password :

* Confirm Password :

First Name :

* Last Name :

Title :

Department :

* Phone Number :

Fax :

* User Type :

* Company(s)

	Available Company(s)

	ALTA MED	AMC
	COUNTY MEDICAL SERVICES PROGRAM	CMSP
	COUNTY OF FRENSO	FEMS
	ORANGE COUNTY HEALTH CARE AGENCY	OCHCA
	PREFERRED	PMG
	VIVANT HEALTH	RCMG
	COUNTY OF SACRAMENTO	SAC
	SAN JUDAS	SJM
	SEOUL MEDICAL GROUP	SMG

	Selected Company(s)

* Provider(s)

Provider NPI:

Provider Tax ID:

Last Name:

First Name:

	Provider Name	Provider ID	Company ID

	Provider Name	Provider ID	Company ID

* Vendor(s)

Vendor ID:

Vendor Name:

	Vendor Name	Vendor ID	Company ID

	Vendor Name	Vendor ID	Company ID

* Facility(s)

Facility ID:

Facility Name:

	Facility Name	Facility ID	Company ID

	Facility Name	Facility ID	Company ID

Type the letters you see in the below picture

* Captcha :

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

EZ-NET v6.7.0