Welcome to the CRISP Registration site!
Please fill out the information below. If you do not have a DEA number or Maryland license number, please register
here
.
Note: this registration process includes an identity authentication step (questionnaire information is not stored), an electronic Memorandum of Understanding, and a required PDMP training video. It is estimated to take 30 minutes to complete the full process.
Member Title
--None--
Cancer Registrar
Certified Nurse Midwife
Clinical Pharmacist
Dentist
Family Reunification User
Hospital Validation
Licensed Clinical Social Worker
LTC Consultant Pharmacist
Medical Assistant
Nurse Practitioner
Nursing Home Administrator
Nursing Home Other Staff
OCME Investigator
Other Licensed Healthcare Practitioner
Other Non-Licensed Staff
Payor User
Pharmacist
Pharmacist, Resident
Pharmacy Technician
Physician
Physician, Intern
Physician, Resident
Physician Assistant
Podiatrist
Practice Manager/Administrator
Public Health Personnel
Registered Dietician
Registered Nurse
Researcher
Scribe
Veterinarian
Prescribing DEA Number
Healthcare Professional License Number
License formatting:
Dentists
: please enter a license number with no leading zeros (e.g. if your license number is 00321, enter 321).
Midwives
: please enter a 7-character license number (e.g. 7654321).
Nurse Practitioners
: please enter a 7- or 8-character license number (e.g. R654321, AC654321)
Physicians
: please enter an 8-character license number (e.g. D0054321, NOT D54321)
Physician Assistants
: please enter a 8-character license number (e.g. C0004321)
Podiatrists
: please enter a license number with no leading zeros (e.g. if your license number is 00321, enter 321).
Veterinarians
: please enter a 4- or 5-digit license number with no leading zeros (e.g. if your license number is 004321, enter 4321).
Fill these in if you are
not
human.
First Name:
Last Name:
Enter only the
red
characters to proceed.
7
p
a
e
j
4
x
6
w
1
a
g
If you have any questions, do not hesitate to contact the CRISP member services team at 1-877-952-7477. Phone support hours are 8 a.m. to 5 p.m. on weekdays. You may also email us at support@crisphealth.org.
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Contact Us
CRISP · 7160 Columbia Gateway Drive, Suite 230 · Columbia, Maryland 21046 · T/
877-952-7477
· F/
443-817-9587
·
support@crisphealth.org