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User Type: Facility ID: User name: Password:
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Facility registration image

* - Required

1. Facility Information

* Facility name

* Facility category

* Location

 

* Trauma Center Level

 

* Street line 1

Street line 2

* City

* Country

State or province

* ZIP or postal code

* Telephone

* Fax

Medicare Provider Number

NPI

Physician Group / Corporate Entity Click for element definition

Should the invoice for this Facility ID Physician Group / Corporate Entity be sent to this Facility ID or a different Facility ID?


Facility ID to which invoice should be sent

2. NRDR Facility Administrator Information - person who will serve as the point of contact with the ACR about NRDR

* First name

* Last name

* E-mail

* Confirm E-mail

* Password  Click for element definition

* Confirm Password

Specialization

Office phone

Mobile phone

Address

Additional information

3. Please include my facility in the list on the website of registered NRDR facilities
4. * Security Text
Enter the code you see on the image:

  

Headquarters Office: 1891 Preston White Dr, Reston, VA 20191, (703) 648-8900
Clinical Research Office: 1818 Market St, Suite 1600, Philadelphia, PA 19103, (215) 574-3150
Government Relations Office: 505 9th St., N.W., Suite 910, Washington, DC 20004, (202) 223-1670
© 2004-2006 American College of Radiology
Version: 8.76.1158