Provider Registration

The following errors occurred:

To use the secured provider areas on, you must complete the registration form below.

General Person Data

Provider - Specific Person Data

Organization Information

Provider - Specific Organization Data

Add Additional Affiliated Tax ID: If your organization is affiliated with additional organizations (subsidiary organizations) that your users will need access to, use this link to add them to your security. If you do not add these additional tax ids now you will need to contact the Medica Registration Administrator and complete additional paperwork to have the additions completed.

Fed tax ID Organization name

Terms of use

This is a secured site and is governed by the terms below. Please be aware that the person who is named in this portion of the registration will be responsible for setting up and maintaining all additional users and agrees to the following terms:

Disclaimer: All information on Medica's provider portal is provided “AS IS” and without warranties of any kind. Medica does not warrant that the content of Medica's provider portal is accurate, reliable, error-free, that defects will be corrected, or that Medica's provider portal or its server are free of viruses or other harmful components. If there is any conflict between the information you obtain on Medica's provider portal and your participation agreement with Medica (including the Administrative Requirements and Credentialing Plan), the latter governs.

  • Keep your User ID and Password confidential and do not share it with anyone else.
  • Register only additional personnel within your organization who have a legitimate need to use the secured portions of for doing business with us.
  • Only allow access to the information a user requires to perform his or her job responsibilities.
  • Monitor on a regular basis who within your organization has access to the secured portions of and what transactions such persons have access to. Make all appropriate modifications to each such user's rights.
  • When personnel leave your organization, you or a Secondary Administrator must promptly deactivate that user's account.
  • Advise all users that they are bound by the terms above.