Web Registration Page

Use the Web Registration page to register for Web access to the NH MMIS Health Enterprise Portal.

Web Registration Fields

Field Description
NH Title XIX Provider #/Trading Partner # The New Hampshire Title XIX provider or trading partner identification number.
SSN/FEIN The provider's individual Social Security number or the organization's Federal Employer Identification number (FEIN). The SSN/FEIN must match what was entered on the enrollment application.

 

Organization Administrator Fields

Field Description
Organization Description

Short description for the organization name. Up to 320 characters is allowed.

Example: Primary care group for the ABC Healthcare System.
Organization Name

Name of the practice or organization in which the Provider Organization Administrator resides.

Example: ABC Medical Group
User ID

The organization administrator ID you want to use when logging on to the NH MMIS Health Enterprise Portal.

User IDs:

  • Are unique
  • Contain 6 to 16 alphanumeric characters
  • Contain no spaces

  • May contain one or more of the following special characters: hyphen (-), underscore (_), or period (.)

  • Conform to any other policies set by your organization
Prefix

The prefix of the organization administrator for your practice or organization.

Examples: Mr., Mrs.
Last Name The last name of the organization administrator for your practice or organization.
First Name The first name of the organization administrator for your practice or organization.
MI The middle initial of the organization administrator for your practice or organization.
Suffix

The suffix of the organization administrator for your practice or organization.

Examples: Sr., Jr., etc.
Phone # The phone number of the organization administrator for your practice or organization.
Ext The extension of the organization administrator for your practice or organization.
Email The e-mail address of the organization administrator for your practice or organization.