DMERX - Clinician Sign Up

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Clinician Sign Up

PLEASE NOTE: Prescriber credentialing is required by various regulatory agencies, insurance groups and pharmacies, as part of the registration process for use of the DMERX exam and documentation website.

Please provide the required credentialing information at time of your DMERX registration. Following your registration, you will receive an email from DMERX containing a link that will allow you to activate your account and begin using the DMERX website.

Attention: Practice information MUST MATCH THE NPI REGISTRY or we cannot send you an activation notification to allow you to activate and use the DMERX website. If your current Practice address is different than the NPI Registry, you will need to use the NPI registered address. If your practice address is not current, please log into your NPI registry account and update it. Once the NPI registered address has been updated, you can then update your account profile in DMERX and change the practice address there to match the NPI registered address.
The information you provide will remain confidential. DMERX does not share your information with outside sources.
For security and compliance purposes, DO NOT give your user name and password to ANYONE.
Items marked with (*) are required.

First Name:	*
Middle Name:
Last Name:	*
Title:	*	(MD, DO, etc)
NPI:	*
DEA:		(Prescribers only)
DOB:	*
Gender:	*	Male Female
Clinician Role:	*
Exam Encounters:	*	Home Clinic Telemed Select all exam encounters accepted
Email:	*
Confirm Email:	*
Clinician Home Address is required for verification and credentialing. Not required for non-prescribing clinicians.
Home Address 1:
Home Address 2:
Home City:
Home State:
Home Zip:

NOTE: Practice info must match NPI Registry. If different, please update your information in the NPI registry database. Your registration cannot be completed until your practice info matches the NPI registry. View NPI Registry
Practice Name:	*
Practice NPI:
Address 1:	*
Address 2:
City:	*
State:	*
Zip:	*
Office Phone:	*
Fax:	*
Time Zone:	*
What's the sum of 6+5? (spam protection)	*