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ESSENCE Provider Portal Account Registration

* Denotes required field
Personal Information
First Name:*    
Middle Initial:  
Last Name:*    
Business Address 1:*  
Business Address 2:
City: *  
State: *  
Zip:*    
Business Phone:* ()     Ext:      
 (XXX)   XXX-XXXX                XXXXX
Business Fax:* ()      
 (XXX)   XXX-XXXX
Email:*    
Confirm Email:*    
Time Zone:

Account Information:
New Login ID:*    
Login ID Criteria
  • Needs to be between 6 and 50 characters
  • May contain all letters or a combination of letters and numbers
  • May not contain spaces
New Password: You will receive an email with your new temporary password
Security Word Hint:*  
Security Word:*  
Confirm Security Word:*    

Provider Access Information
Provider/Group/Facility Name:
ESSENCE Provider?
Primary Care Provider?
Access Level Requested?
* Referrals for Primary Care Providers Only
Requesting Access To:
Name 1: NPI: Tax Id:
      
Name 2: NPI: Tax Id:
      
Name 3: NPI: Tax Id:
      
Name 4: NPI: Tax Id:
      
Name 5: NPI: Tax Id:
      
* Please contact Lumeris Customer Support at 866-397-2812 if you need to request access to more than five providers.

CMS requires Medicare Advantage plans maintain an up to date provider directory, please complete the 'Provider Demographic Change Form' (log into the portal and see link) immediately if you have any demographic changes that need to be reported.

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