NC*Notify Online Enrollment (Access East)

This enrollment form is intended only for practices that are designating Access East as the responsible party for managing their NC*Notify feeds.

To learn more about other options and upgraded features available through NC*Notify, please send an email to hiea@nc.gov.

Organization Information

Organization Name

Organization Address

Address 2

City

State

ZIP Code

Organization Phone Number

Organization Type
(Select all that apply.)

Hospital

Primary Care

Free Clinic

Community Health Center/FQHC

Behavioral Health

Specialist

Other

Other Organization Type

Please be sure to select at least one option above before continuing.

Organization NPI

(Separate multiple NPIs by a comma.)

Medicaid Region
(Select all that apply.)

Region 1

Region 2

Region 3

Region 4

Region 5

Region 6

Please be sure to select at least one option above before continuing.

This question is for testing whether or not you are a human