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MM/DD/YYYY
DME Signup
Email (will be your user name)
Password
User Is Enabled
Full Name
Company Name
Street Address
City
State
ZIP
Mobile
Office Phone
Fax
EIN (Employer Identification Number - Tax ID assigned to your company by the IRS)
NPI (National Provider Identifier )
Medicare Application Status
Date You Applied for Medicare
PTAN (Provider Transaction Access Number - assigned to you by Medicare upon enrollment)
DME Owner's Date of Birth
(
only needed if we are applying to Medicare for you or updating your PTAN
)
DME Owner's Social Security Number
(only needed if we are applying to Medicare for you or updating your PTAN))
Profile Pic
Document Upload: Please upload copies of relevant documentation (accreditation letter, certificates, etc.)
*** Please Note *** :
The billing cycle for your subscription begins once the OR02 Product Category for your DME is approved by BOC. That is the point in which you begin utilizing our Practitioner for your credentialing on a month-to-month basis. We do not wait on your PTAN for Medicare (which can take 60-90 days) nor your first referral to start the billing cycle for your subscription. Once you are BOC approved, you can start dispensing OR02 Orthopedic Braces through any insurance company that you are actively in-network with.
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