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Blue Access for Providers Registration

Field name Value
Group Practice or Facility?
Tax ID Number (TIN):*
Tax ID Number (TIN):*
National Provider Identifier (NPI):*
National Provider Identifier NPI
Type 1 Individual NPI:*

Your First Name:*
Your First Name:* The name of the person registering.

Your Last Name:*
Your Last Name:*
Your Middle Name:
Your Middle Name:
Your Title:
Your Title:
  (We will need your email address to send you confirmation of registration,
so double-check it's the right one!) (example: johndoe@aol.com)
Your Email Address:*
Your Email Address:*
  (Phone Number length is 10 digits, use only numbers.) (example: 9991115555)
Your Phone Number:*
Your Phone Number:*
Required fields *
   

Caution: First time registration must be completed by someone of authority at your practice, such as the Office Administrator. Completion of the registration process will designate you as the "Super User." The Super User will be responsible for adding users and delegating roles.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,
an Independent Licensee of the Blue Cross and Blue Shield Association.
© Copyright 2013. Health Care Service Corporation. All Rights Reserved.

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