Please submit the following information, required fields are marked with an asterisk *

Organization Name *

First Name *

Last Name *

Phone *

Email *

Website *

EHR Vendor AAD’s Data Derm Allscripts Amazing Charts American College of Surgeons Aprima ATHENA Athenahealth Benchmark Prognosis Bizmatics Care360 CARE CLOUD CERNER Cerner Care 4 ChartLogic ClinicSpectrum Cure MD eClinical Works eCW e-MDS EPIC Exscribe Healthcare Orthopeadic Solutions GE Centricity Greenway Health Endeavors Health Fusion Healthland Centric InSync iPatientCare IRIS Registry Master Mind McKesson MD Interactive Medent MedExpress Medflow Holdings, LLC Med Fusion MedGen Medisoft Meditech Meditouch MedWorxs LLC Mingle Analytics MIPS Wizard Modernizing Medicine, Inc Net Practice New York eHealth Collaborative Nextech NextGen Next Smart Office Ally Office Mate Office Practicum Open Dental Practice Fusion PRIME Quadramed Quest diagnostics SOAPware Success EHS Trend Tracker Vendor Vitera Other

Corporate or Organization NPI

TIN

CCN Number

HSP

Number of Clinicians

Ambulatory Surgical Center Facility Type

Community Coalition Group Type

End Stage Renal Disease Center Facility Type

Federally Qualified Health Center Facility Type

Health Department Facility Type

Home Health Facility Type

Hospice Facility Type

Hospital Facility Type

Nursing Home Facility Type

Pharmacy Facility Type

Physician Practice Facility Type

Stakeholder/Partner Group Type

I agree to the General Terms and consent to the collection of personal data pursuant to Alliant Health's Privacy Policy and Cookie Policy.

Comments