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


Medicare Provider Number

(This field is required if your facility intends to use LCSR for Medicare reimbursement.)

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?

Master Facility ID to which invoice should be sent

Additional facility information

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

* User name  Click for element definition

* Password  Click for element definition

* Confirm Password


Office phone

Mobile phone


Facility administrator notes

3. Please include my facility in the list on the website of registered NRDR facilities
(Your facility will be listed automatically if you use LCSR for Medicare reimbursement.)
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: 10.94.7729