Welcome to the CRISP Registration site!
Please fill out the information below. If you do not have a DEA number or Maryland license number, please register
here
.
Note: this registration process includes an identity authentication step (questionnaire information is not stored), an electronic Memorandum of Understanding, and a required PDMP training video. It is estimated to take 30 minutes to complete the full process.
Member Title
Prescribing DEA Number
Healthcare Professional License Number
License formatting:
Dentists
: please enter a license number with no leading zeros (e.g. if your license number is 00321, enter 321).
Midwives
: please enter a 7-character license number (e.g. 7654321).
Nurse Practitioners
: please enter a 7- or 8-character license number (e.g. R654321, AC654321)
Physicians
: please enter an 8-character license number (e.g. D0054321, NOT D54321)
Physician Assistants
: please enter a 8-character license number (e.g. C0004321)
Podiatrists
: please enter a license number with no leading zeros (e.g. if your license number is 00321, enter 321).
Veterinarians
: please enter a 4- or 5-digit license number with no leading zeros (e.g. if your license number is 004321, enter 4321).
Fill these in if you are
not
human.
First Name:
Last Name:
Enter only the
red
characters to proceed.
e
b
8
w
e
x
i
f
7
z
k
u
If you have any questions, do not hesitate to contact the CRISP member services team at 1-877-952-7477. Phone support hours are 8 a.m. to 5 p.m. on weekdays. You may also email us at support@crisphealth.org.
Site Map
HOME
FOR PATIENTS
Patient Information
Opt-Out Information
Patient Privacy
FAQs
CRISP HIE SERVICES
Encounter Notification System (ENS)
Portal
DIRECT Messaging
Prescription Drug Monitoring Program (PDMP)
NEWS & EVENTS
FOR PROVIDERS
Services for Office Based Practices
Regional Extension Center
Services for Hospitals
Services for Long Term Care
Participating Providers
ABOUT
General Info
Governance
Leadership
Policies & Agreements
Contact Us
CRISP · 7160 Columbia Gateway Drive, Suite 230 · Columbia, Maryland 21046 · T/
877-952-7477
· F/
443-817-9587
·
support@crisphealth.org