hcpverify.com
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Submitted URL: https://ebvterms.com/terms
Effective URL: https://hcpverify.com/
Submission: On November 02 via api from US — Scanned from DE
Effective URL: https://hcpverify.com/
Submission: On November 02 via api from US — Scanned from DE
Form analysis 1 forms found in the DOM
<form _ngcontent-pwd-c119="" novalidate="" fxlayout="column" class="provider-form tablet-width ng-untouched ng-pristine ng-invalid" style="flex-direction: column; box-sizing: border-box; display: flex;">
<div _ngcontent-pwd-c119="" fxlayout="column" style="flex-direction: column; box-sizing: border-box; display: flex;">
<div _ngcontent-pwd-c119="" fxlayout="row" fxlayout.sm="column" fxlayout.xs="column" style="flex-direction: row; box-sizing: border-box; display: flex;" class="ng-star-inserted"><mat-form-field _ngcontent-pwd-c119="" appearance="standard"
class="mat-form-field ng-tns-c86-0 mat-primary mat-form-field-type-mat-input mat-form-field-appearance-standard mat-form-field-can-float mat-form-field-has-label ng-untouched ng-pristine ng-invalid mat-form-field-should-float mat-focused">
<div class="mat-form-field-wrapper ng-tns-c86-0">
<div class="mat-form-field-flex ng-tns-c86-0"><!----><!---->
<div class="mat-form-field-infix ng-tns-c86-0"><input _ngcontent-pwd-c119="" matinput="" maxlength="10" type="text" formcontrolname="npi" appautofocus="" autocomplete="off" digitonly=""
class="mat-input-element mat-form-field-autofill-control ng-tns-c86-0 cdk-text-field-autofill-monitored ng-untouched ng-pristine ng-invalid" id="mat-input-0" aria-invalid="false" aria-required="false"><span
class="mat-form-field-label-wrapper ng-tns-c86-0"><label class="mat-form-field-label ng-tns-c86-0 mat-empty mat-form-field-empty ng-star-inserted" id="mat-form-field-label-1" for="mat-input-0" aria-owns="mat-input-0"><!----><mat-label
_ngcontent-pwd-c119="" class="ng-tns-c86-0 ng-star-inserted">Prescriber NPI</mat-label><!----><!----></label><!----></span></div><!---->
</div>
<div class="mat-form-field-underline ng-tns-c86-0 ng-star-inserted"><span class="mat-form-field-ripple ng-tns-c86-0"></span></div><!---->
<div class="mat-form-field-subscript-wrapper ng-tns-c86-0"><!---->
<div class="mat-form-field-hint-wrapper ng-tns-c86-0 ng-trigger ng-trigger-transitionMessages ng-star-inserted" style="opacity: 1; transform: translateY(0%);"><!---->
<div class="mat-form-field-hint-spacer ng-tns-c86-0"></div>
</div><!---->
</div>
</div>
</mat-form-field><!---->
<div _ngcontent-pwd-c119="" fxlayout="column" fxlayoutalign="center center" style="flex-direction: column; box-sizing: border-box; display: flex; place-content: center; align-items: center;"><!----></div>
</div><mat-form-field _ngcontent-pwd-c119="" appearance="standard"
class="mat-form-field ng-tns-c86-1 mat-primary mat-form-field-type-mat-input mat-form-field-appearance-standard mat-form-field-can-float mat-form-field-has-label mat-form-field-hide-placeholder ng-untouched ng-pristine ng-invalid ng-star-inserted">
<div class="mat-form-field-wrapper ng-tns-c86-1">
<div class="mat-form-field-flex ng-tns-c86-1"><!----><!---->
<div class="mat-form-field-infix ng-tns-c86-1"><input _ngcontent-pwd-c119="" matinput="" maxlength="10" formcontrolname="dateOfBirth" autocomplete="off" placeholder="MM/DD/YYYY"
onkeydown="this.value=this.value.replace(/^(\d\d)(\d)$/g,'$1/$2').replace(/^(\d\d\/\d\d)(\d+)$/g,'$1/$2').replace(/[^\d\/]/g,'')" digitonly=""
class="mat-input-element mat-form-field-autofill-control ng-tns-c86-1 cdk-text-field-autofill-monitored ng-untouched ng-pristine ng-invalid" id="mat-input-1" aria-invalid="false" aria-required="false" aria-haspopup="dialog"
max="2022-11-02"><mat-datepicker _ngcontent-pwd-c119="" class="ng-tns-c86-1"></mat-datepicker><!----><span class="mat-form-field-label-wrapper ng-tns-c86-1"><label
class="mat-form-field-label ng-tns-c86-1 mat-empty mat-form-field-empty ng-star-inserted" id="mat-form-field-label-3" for="mat-input-1" aria-owns="mat-input-1"><!----><mat-label _ngcontent-pwd-c119=""
class="ng-tns-c86-1 ng-star-inserted">Date of Birth</mat-label><!----><!----></label><!----></span></div>
<div class="mat-form-field-suffix ng-tns-c86-1 ng-star-inserted"><mat-datepicker-toggle _ngcontent-pwd-c119="" matsuffix="" class="mat-datepicker-toggle ng-tns-c86-1" tabindex="-1"><button mat-icon-button="" type="button"
class="mat-focus-indicator mat-icon-button mat-button-base" aria-haspopup="dialog" aria-label="Open calendar" tabindex="0"><span class="mat-button-wrapper"><svg viewBox="0 0 24 24" width="24px" height="24px" fill="currentColor"
focusable="false" class="mat-datepicker-toggle-default-icon ng-star-inserted">
<path d="M19 3h-1V1h-2v2H8V1H6v2H5c-1.11 0-1.99.9-1.99 2L3 19c0 1.1.89 2 2 2h14c1.1 0 2-.9 2-2V5c0-1.1-.9-2-2-2zm0 16H5V8h14v11zM7 10h5v5H7z"></path>
</svg><!----></span>
<div matripple="" class="mat-ripple mat-button-ripple mat-button-ripple-round"></div>
<div class="mat-button-focus-overlay"></div>
</button></mat-datepicker-toggle></div><!---->
</div>
<div class="mat-form-field-underline ng-tns-c86-1 ng-star-inserted"><span class="mat-form-field-ripple ng-tns-c86-1"></span></div><!---->
<div class="mat-form-field-subscript-wrapper ng-tns-c86-1"><!---->
<div class="mat-form-field-hint-wrapper ng-tns-c86-1 ng-trigger ng-trigger-transitionMessages ng-star-inserted" style="opacity: 1; transform: translateY(0%);"><!---->
<div class="mat-form-field-hint-spacer ng-tns-c86-1"></div>
</div><!---->
</div>
</div>
</mat-form-field><!----><!----><!----><!---->
</div>
<div _ngcontent-pwd-c119="" class="actions-group"><!---->
<div _ngcontent-pwd-c119="" class="actions-title text-muted app-font">Is this information accurate?</div>
<div _ngcontent-pwd-c119="" fxlayout="row" fxlayoutalign="start stretch" fxlayoutgap="10px" class="actions"
style="flex-direction: row; box-sizing: border-box; display: flex; place-content: stretch flex-start; align-items: stretch; max-height: 100%;"><button _ngcontent-pwd-c119="" mat-raised-button="" color="primary" type="submit"
class="mat-focus-indicator submit-button btn-extended-width mat-raised-button mat-button-base mat-primary" disabled="true" style="margin-right: 10px;"><span class="mat-button-wrapper"><!----><span _ngcontent-pwd-c119="">Yes,
continue</span></span>
<div matripple="" class="mat-ripple mat-button-ripple"></div>
<div class="mat-button-focus-overlay"></div>
</button><button _ngcontent-pwd-c119="" mat-stroked-button="" type="button" class="mat-focus-indicator cancel-button mat-stroked-button mat-button-base"><span class="mat-button-wrapper"> No </span>
<div matripple="" class="mat-ripple mat-button-ripple"></div>
<div class="mat-button-focus-overlay"></div>
</button></div>
</div>
</form>Text Content
HCP Verification 1 Enter Your Info 2 Verify Your Identity 3 Give Consent 4 Provide Your Email WHY SHOULD YOU REGISTER YOUR NPI WITH US? This one-time, registration enables you and your staff to access AssistRx real-time benefit information, e-prior authorization and program enrollment for your patients. Your information is secure and will not be displayed to office staff or shared with any external party. © 2020-2021 AssistRx. All Rights Reserved. Intended for US residents only. Terms HCP Verification Why should you register your NPI with us? This one-time, registration enables you and your staff to access AssistRx real-time benefit information, e-prior authorization and program enrollment for your patients. Your information is secure and will not be displayed to office staff or shared with any external party. 1 Enter Your Info VERIFY NOW Enter Your Info Enter your 10-digit NPI, and date of birth. These will be used to populate two security questions to verify your identity. This protects healthcare providers and patients from potentially fraudulent activity. Prescriber NPI Date of Birth Is this information accurate? Yes, continue No 2 Verify Your Identity 3 Give Consent 4 Provide Your Email © 2020-2021 AssistRx. All Rights Reserved. Intended for US residents only. Terms Live Chat: Online Live Chat: Offline Live Chat: Online Live Chat: Offline Now Chatting