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Step 1 of 5 — Company Info 20% complete
Step 1 of 6

Company information

Tell us about your DME company. This is the primary contact we'll use for all communications.

Company name is required.
Contact name is required.
A valid email address is required.
Step 2 of 6

Address & service area

Where are you located, and where do you ship to? We use this to match you with patients nearby.

Mail order / nationwide provider
You ship to patients across multiple states, not just locally
Select all states where you accept patients or ship equipment.
Please select at least one state.
Do you serve the entire state(s) selected above, or only specific cities/ZIP codes within those states?
Please select a coverage scope.
Enter all cities and/or ZIP codes where you accept patients. Be specific — leads outside these areas won't be sent to you.
Please enter at least one city or ZIP code.
Step 3 of 6

Equipment categories

Which types of DME do you supply? We'll only send you referrals for equipment you provide.

Please select at least one category.
Step 4 of 6

Insurance accepted

Which payers do you bill? We match you with patients whose insurance you accept.

Please select at least one insurance type.
Step 5 of 6

Referral preferences

When we send you a patient, how does your team prefer to receive it? This ensures referrals actually reach the right person.

Select all that apply. We'll use your preferred channel(s) when sending you a match.
Please select at least one referral method.
The fax number we should send referral documentation to.
Use this if your referral inbox is different from your main contact email.
Select everything we should include when sending you a patient match.
Step 6 of 6

Accreditation & compliance

Almost done! Provide your Medicare identifiers and acknowledge our compliance requirements.

Your 10-digit CMS NPI. Used to verify Medicare enrollment status.
Your Medicare PTAN, if applicable.
All three statements below are required to join the network.
Federal Healthcare Compliance — Anti-Kickback Statute & Stark Law
You must acknowledge all three compliance statements to proceed.
Network participation notice: Network participation is voluntary and involves no referral fees. Patient routing is based on insurance compatibility, service area, and equipment availability. Joining this network does not guarantee any specific volume of patient contacts. You are free to decline any patient lead.

Application submitted!

Thank you for joining the SME partner network. Our team will review your application and be in touch within 2 business days.

Keep this reference ID for your records. Check your email for a confirmation.