An official website of the United States government
The Professional Administrator Information page lets you enter information for the professional administrator account you are creating.
| Field | Description |
|---|---|
| Employer Identification Number (EIN) | Enter the IRS-assigned EIN associated with the organization. Required. |
| Corporation Name | Enter your company name. Required. |
| Address Line 1 | Enter line 1 of your company’s mailing address. Required. |
| Address Line 2 | Enter line 2, if any, of your company’s mailing address. |
| City | Enter the city where the company is located. Required. |
| State | Select the state where the company is located from the drop-down menu. Required. |
| Zip Code | Enter the ZIP code where the company is located. Five-digit code required; +4 portion optional. |
Click Next to continue.
Click Previous to return to the Select Account Type page.
Click Cancel to return to the Welcome page.
A federal government website managed and paid for by the U.S. Centers for Medicare and Medicaid Services.
7500 Security Boulevard, Baltimore, MD 21244