Provider Registration

To Register:

All fields marked with are required.
At least one NPI or TIN is required. Multiple IDs may be entered but must be separated by commas. No spaces are allowed.
NPIs are 10 numeric digits and TINs are 9 digits. Hyphens (-) are not allowed. Please include leading zeroes as needed.
If you have any questions or require support, please contact support.information@healthsmart.com for assistance.

NPIs

TINs

First Name

Last Name

Practice Name

Address

City

State
Zip

Phone

Unformatted 10-digit numbers only

Confirm Email

Username

Alphanumeric and can only contain these special characters _ @ . , '

Password

Must be a minimum 12 characters in length
Contain at least 1 Uppercase letter (A-Z), 1 Lowercase letter (a-z), 1 Digit (0-9), and 1 Special character (~`!@#$%^&*()+=_-{}[]\)

Confirm Password