Empathic: Register

Registration

Your Info:Tell us about yourself!1.

First Name:

Middle Name:

Last Name:

Email:

Phone:

Your NPI:

SSN:

Use clinic EIN for Federal Tax ID

Use your SSN for Federal Tax ID

Desired Username:

Password:

Password Confirm:

Clinic Info:Tell us about your clinic!2.

Clinic Name:

Clinic NPI:

Clinic Tax ID:

Clinic Address: Clinic physical address3.

Lookup 9 Digit Zip

My Clinic Address is also my Billing Address

Billing Address: Clinic's billing address 4.

Use only your physical street address here. No PO Boxes are allowed. You can use a PO Box for mailing address.

Lookup 9 Digit Zip

Practice ContinuityDesignated Practice Closer 5.

It is an ethical standard, that each clinician designate someone to close his/her practice in the unfortunate event of death, or inability to continue practicing. Empathic needs to know who has responsibility for your client/patient information in the event you are no longer able to manage your practice.

I have a designated closer.

First Name:

Last Name:

Credentials:

Address:

Phone:

If you have not designated someone to close your practice, you may contact Steve Frankel at the Steve Frankel Group for information on how to make sure you are in compliance with end of practice requirements. (925) 263-2835 (voice)

Cancel

Your password must be at least 8 characters and contain uppercase, lowercase, number, and a special character.

If you do not have an NPI or you are registering a second account under the same NPI, please use the NPI 1234567893 on this screen. If you need to update your NPI, you can do this once your account is created on the ‘My Account’ screen.