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Enrollment

Re-Enrollment

Enter a SSN or TaxID and click Start.

Applicant identification

If enrolling an individual practitioner, type the Social Security Number. If an individual has a Federal Taxpayer ID, you will need to complete two applications and two contracts. One as an individual and one as an organization. If enrolling a sole proprietorship, type either the Social Security Number or Federal Taxpayer ID.


 


NOTICE: Use of this application is restricted to authorized users. User activity is monitored and recorded by system personnel. Anyone using this application expressly consents to such monitoring and recording. BE ADVISED: if possible criminal activity is detected, system records, along with certain personal information, may be provided to law enforcement officials.