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Web Registration Page

Use the Web Registration page to register for Web access to the North Dakota MMIS Web Portal.

 

Web Registration Fields

Field Description
ND Provider #/Trading Partner # The North Dakota provider or trading partner identification number.
SSN/EIN The provider's individual Social Security number or the organization's employer identification number EIN). The SSN/EIN must match what was entered on the enrollment application.

 

Organization Administrator Fields

Field Description
Organization Description

Short description for the organization name. Up to 320 characters is allowed.

Example: Primary care group for the ABC Healthcare System.
Organization Name

Name of the practice or organization in which the Provider Organization Administrator resides.

Example: ABC Medical Group
User ID

The organization administrator ID you want to use when logging on to the North Dakota MMIS Web Portal.

User IDs:

  • Are unique
  • Contain 6 to 16 alphanumeric characters. Letters are stored as upper-case.
  • Contain no spaces
  • May contain one or more of the following special characters : hyphen (-), underscore (_), or period (.)
  • Conform to any other policies set by your organization
Prefix

The prefix of the organization administrator for your practice or organization.

Examples: Mr., Mrs.
Last Name The last name of the organization administrator for your practice or organization.
First Name The first name of the organization administrator for your practice or organization.
MI The middle initial of the organization administrator for your practice or organization.
Suffix

The suffix of the organization administrator for your practice or organization.

Examples: Sr., Jr., etc.
Phone # The phone number of the organization administrator for your practice or organization.
Ext The extension of the organization administrator for your practice or organization.
E-mail The e-mail address of the organization administrator for your practice or organization.

 

Version as of 5/16/14.

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