First Name * Last Name * NPI * Click here to use the NPI Lookup from HHS and cut and paste results into the form. AMDA Member ID * Facility State * Facility City * Facility Name * Facility Name Facility Name Years practicing in PALTC * Are you participating in an ACO? * Yes No ACO / Accountable Care Organization Are you participating in BPCI? * Yes No BPCI / Bundled Payments for Care Improvement Do you have advanced practice nurses care for your patients routinely? * Yes No In this facility I serve as: * Medical Director Attending Physician Both, Medical Director and Attending Physician CAPTCHA I am not a robot Submit
