User Account Information

Fields marked with * are required

* First Name
* Last Name
* Email Address
* Practice / Organization Name
* State/Territory
* Phone
(xxx-xxx-xxxx)
Phone extension
(Optional)
* Number of Clinicians
* Submission Type
  • Report as an individual(s) - multiple individual clinicians can use the same
    account to report MIPS. The MIPS scoring will be based on each individual's performance.
  • Report as a group - Each eligible clinician participating in MIPS via a group will
    receive the same MIPS score based on the group's performance:
    		•
     
    * Choose a username:
    (minimum of 3 characters)
    * Choose a good password:
    (minimum of 8 characters)
    * Re-enter password for verification:
     
    Please create only one account per group
    By clicking 'Continue' you are indicating that you have read and agree to the terms and conditions of our "Software License Agreement" and "Business Associate Agreement" on behalf of the clinician(s), group(s) and organization(s) being reported.
    Once an account is created with our registry, MDinteractive should send you a confirmation email.
    If an email is not received, contact MDinteractive at 800-634-4731.

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