Health Smart Logo
Print this page

Provider Registration


Step 1 of 2: Personal Information

Please take a moment and provide us the information we need to create your account. Please note, providers can only register one tax identification number per username. If you are a provider or billing service with more than one tax identification number, you must register a separate account for each.

* Tax ID:
* First Name:
* Last Name
Practice Name:
* Address Line 1:
Line 2:
* City:
* State:
* Zip:
* Telephone: Extension:
Providing your telephone number will allow us to contact you to assist with any problems that you may encounter with our website. This information is strictly for website assistance and will not be shared.


Activity on this web site is monitored for quality purposes.
For technical assistance, please email our help desk