hcpverify.com
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Submitted URL: https://ebvterms.com/
Effective URL: https://hcpverify.com/
Submission: On May 30 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://hcpverify.com/
Submission: On May 30 via automatic, source certstream-suspicious — Scanned from DE
Form analysis
1 forms found in the DOM<form _ngcontent-eft-c115="" 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-eft-c115="" fxlayout="column" fxlayout.sm="row" style="flex-direction: column; box-sizing: border-box; display: flex;">
<div _ngcontent-eft-c115="" 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-eft-c115="" appearance="standard"
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<div class="mat-form-field-wrapper ng-tns-c84-0">
<div class="mat-form-field-flex ng-tns-c84-0"><!----><!---->
<div class="mat-form-field-infix ng-tns-c84-0"><input _ngcontent-eft-c115="" matinput="" maxlength="10" type="text" formcontrolname="npi" appautofocus="" autocomplete="off" digitonly=""
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_ngcontent-eft-c115="" class="ng-tns-c84-0 ng-star-inserted">Prescriber NPI</mat-label><!----><!----></label><!----></span></div><!---->
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<div class="mat-form-field-underline ng-tns-c84-0 ng-star-inserted"><span class="mat-form-field-ripple ng-tns-c84-0"></span></div><!---->
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<div _ngcontent-eft-c115="" 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-eft-c115="" appearance="standard"
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<div class="mat-form-field-wrapper ng-tns-c84-1">
<div class="mat-form-field-flex ng-tns-c84-1"><!----><!---->
<div class="mat-form-field-infix ng-tns-c84-1"><input _ngcontent-eft-c115="" 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=""
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max="2022-05-30"><mat-datepicker _ngcontent-eft-c115="" class="ng-tns-c84-1"></mat-datepicker><!----><span class="mat-form-field-label-wrapper ng-tns-c84-1"><label
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class="ng-tns-c84-1 ng-star-inserted">Date of Birth</mat-label><!----><!----></label><!----></span></div>
<div class="mat-form-field-suffix ng-tns-c84-1 ng-star-inserted"><mat-datepicker-toggle _ngcontent-eft-c115="" matsuffix="" class="mat-datepicker-toggle ng-tns-c84-1" tabindex="-1"><button mat-icon-button="" type="button"
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<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>
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<div class="mat-form-field-underline ng-tns-c84-1 ng-star-inserted"><span class="mat-form-field-ripple ng-tns-c84-1"></span></div><!---->
<div class="mat-form-field-subscript-wrapper ng-tns-c84-1"><!---->
<div class="mat-form-field-hint-wrapper ng-tns-c84-1 ng-trigger ng-trigger-transitionMessages ng-star-inserted" style="opacity: 1; transform: translateY(0%);"><!---->
<div class="mat-form-field-hint-spacer ng-tns-c84-1"></div>
</div><!---->
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<div _ngcontent-eft-c115="" class="actions-group">
<div _ngcontent-eft-c115="" class="actions-title text-muted app-font">Is this information accurate?</div>
<div _ngcontent-eft-c115="" 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-eft-c115="" mat-raised-button="" color="primary" type="submit"
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continue</span></span>
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<div class="mat-button-focus-overlay"></div>
</button><button _ngcontent-eft-c115="" 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: Offline Live Chat: Online