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

This form can be used by facilities or physician groups or other entities but you need to have one registration for each location at which you practice. Please refer to NRDR for more instructions for registering multiple facilities.

* - 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