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Provider Registration Template

If your medical group has no record of previously registered providers on the MNCM data portal, please use the template provided to create a new list of providers.

The template will download as an excel workbook. Please update the excel file to include all necessary information. Then, the file will need to be saved as a CSV file before it can be uploaded onto the portal. Please see the registration guide (also attached) for details about required information in the provider file.

Creation date: 1/2/2019 12:48 PM Updated: 10/27/2022 7:38 AM

Provider_Registration_Spreadsheet_Template_FINAL.xls

Provider_Registration_Spreadsheet_Template_FINAL.xls

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	Provider_Registration_Spreadsheet_Template_FINAL.xls 24 KB

Resources for annual clinic and provider registration