Provider Enrollment - Stryker IVS

Enrolling As

Are you employed by the:

Physician’s Office to submit Prior Authorizations, Appeals or Physician Claim Appeals

Facility to submit only Post-service Claim Appeals for the Service

Both

User Information

User Contact Name

First

Last

User Contact Email

User Contact Phone

Add Remove

Practice Information

Physicians Office Name

Phone Number

Fax Number

Physician’s Address

Physician's Address

City

State/Province

Zip/Postal

Physicians Office Tax ID

Physicians Office NPI

Physicians Office PTAN

Physician Information

Physician Name

Physician NPI

Physician Tax ID

Individual Physician PTAN

Add Remove

Facility Information (where cases will be performed)

Facility Name (where cases will be performed)

Facility Address

City

State

ZIP Code

Phone Number

Fax Number

Facility Tax ID

Facility NPI

Facility PTAN

Add Remove

Facility Physician Information

Facility Physician Name

Facility Physician NPI

Facility Physician Tax ID

Facility Physician PTAN

Add Remove

Stryker IVS Reimbursement Specialist Name