Physician Registration

First Name*

Last Name*

Clinic/Hospital Name*

Address1*

Address2

City,State, Zip*

select

NPI#*

Phone#*

Fax#*

Email Address*

Confirm Email Address*

Username*

Password *
Confirm Password *

The PHI (Personal Health Information) contained on this secure website is HIGHLY CONFIDENTIAL. It is to be used only to aid in providing specific healthcare services to this patient. Any other use is a violation of Federal Law (HIPAA) and will be reported as such. Any complaints or concerns can be reported to the Privacy and Compliance Officer at 1-866-575-8483 or emailed to nssprivacyofficer@vgm.com. Written complaints may be submitted to National Sleep Services, Attention: Privacy Officer, 1111 Van Miller Way, Waterloo, Iowa 50701.
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