Welcome to the team!
Thank you for choosing to partner with Sure Med Compliance. To sign up for our services, please fill out this form.
(If you are a patient trying to enroll in the Care Continuity Program, please click
HERE
to be redirected to the appropriate page.)
(If you are a ProAssurance Insured, please click
HERE
for a special offer.)
In order to complete the enrollment process, you will need the following information. Make sure you have this information on hand before you continue:
1. The NPI number of all primary physicians that you want to enroll
2. The NPI number of all mid-level physicians that you want to enroll
3. The organization NPI of all locations you want to enroll in which your primary and mid-level physicians practice
Contact Name:
Please enter your name.
Contact Email:
(Attention: This email will be used for all official correspondance with Sure Med Compliance.)
Your email address is required!
Contact Phone:
(Attention: This number will be used for all official correspondance with Sure Med Compliance.)
Please enter your phone number
How many prescribers (users) do you have in your practice? (Please include all healthcare providers in your practice that treat patients.)
Primaries:
1
2
3
4
5
6
7
8
9
9+
Mid Levels:
0
1
2
3
4
5
6
7
8
9
9+
Are you or your practice currently under investigation by any federal/state institutions and/or regulatory body?
No
Currently under investigation
Your needs are important to us.
We'd like to contact you directly for a pricing quote because of the large number of providers in your practice and to discuss potential discounts.
Your needs are important to us.
We'd like to contact you directly for a pricing quote because of the current status your practice and to discuss an initial quote.
Please press the button below to continue.