You must have an Email address to become a listed provider. Your email address will be your login name and all correspondence about your account will be done via email. Your email address will NOT be displayed in the public listing of your account unless you remove the check from the check box provided. If you want your email address included in your public listing you must remove the check from the check box.
If you do not have an email account there are free services available. Among the popular ones are Microsoft's Hotmail and Yahoo.

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Enter your First Name in the first text box and your Last Name in the second box exactly as you want them to display in your listing. Include any credentialing initials (eg. MD, PT, DDS) after your Last Name.
For example, First Name= Steven, Last Name= Woods, MD, FAAP will display as:
Steven Woods, MD, FAAP

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Enter the phone number where you can be reached to answer any questions or clarify the information you have submitted here. This phone number will NOT display to the public when your listing is added to the live database. Enter the area code and 7 digit phone number as shown in the example.

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Select the specialties from the list that define your area of expertise and/or specialty training. To select more than one specialty, hold down the Control (CTRL) key on your keyboard and then click on each of the specialties you wish to select. If the specialty you are looking for is not available, you can list this information in the Other Specialties text box. If you would like us to consider adding a specialty to the existing list, please contact us by email and provide the specialty information to be considered.

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This is an Optional Field. Enter any Specialties or Sub-specialties you may have that are not included in the previous Specialties List. This field is not included in the Specialties search feature - users will not be able to locate your listing based upon content you have entered in this field. Examples: Neuropathology, Cardiac Electrophysiology.

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This is an Optional Field. Leave the check box blank if you are not a Board Certified Physician. Check the box if you are a Board Certified Physician. The text field can be used to describe the status of a pending application for Board Certification or any other details you wish to provide about your Board Certification.

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This is an Optional Field. Leave the check box blank if you are not an Approved DSCC (Division of Specialized Care for Children) Provider. Check the box if you are an Approved DSCC (Division of Specialized Care for Children) Provider. If you have applied for DSCC approval, you can use the text field to describe the status of your application. You can also use the text field to describe your membership in an approved Team or Center. For example, member of Rush Hemophilia Center team, member of Loyola Craniofacial Team, or member of St. Johns Center Based Therapy group.

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This is an Optional Field. Leave the check box blank if you are not an Approved Medicaid Provider. Check the box if you are an Approved Medicaid Provider. The text field can be used to describe the status of a pending Medicaid Provider application or any other details you wish to provide about your Medicaid Provider status.

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This is an Optional Field. Leave the check box blank if you are not a member of a Managed Care Organization (MCO)or Preferred Provider Network (PPN). Check the box if you are a member of a MCO or PPN. The text field can be used to describe the status of a pending application or any other details you wish to provide about your member status.

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Clients may have a gender preference when selecting a health care provider. If you wish to provider information on your gender, select F for Female or M for Male. This is an OPTIONAL field; the default selection is a hash mark.

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This is an Optional Field. You can use this text field to describe any special or unique health care interests or expertise you may have. For example: "I have specialized in the management of children with Riley-Day Syndrome (Familial Dysautonomia)."

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