Request Provider Registration Verification

In order to access claims and eligibility information online Providers must register with J.P. Farley.

If you completed our Provider Registration Form but have not received a message acknowledging a completed registration or a message stating your TIN or NPI number cannot be found please complete the form so that we may assist you in the next step in your provider registration process.

Once J.P. Farley has verified your Registration and activated your account you will be contacted by a representative via email.

Type of Registration *

Contact First Name *

Last Name *

Provider or Facility Name
(must match Provider Registration Form) *

Email (kept private) *

Post Registration Message Received *

Your Account Is Pending
Your TIN and/or NPI Could Not Be Found
Other

Preferred Username

Tax Identification Numbers (TIN)
Enter all TINs related to you. *

National Provider ID (NPI)
Enter all NPIs related to you. *

Have you provided J.P. Farley with a recent W-9?
If not, please send a copy to benefits@jpfarley.com or reply email you receive. *

Physical Office/Facility Address *

City *

State *

Zip *

Phone *

Billing Addresses *

Comments/Questions: