Order Confidential Practice Profile

A profile is available to you only if you meet the following criteria:

You billed Medicare for services under your Unique Physician Identification Number (UPIN) in 2001
You were considered the primary care physician (the physician the patient saw most frequently) in Georgia for at least five Medicare patients

If you do not meet these criteria, we will inform you in writing.

If you would like a copy of your own individual profile of 2001 Diabetes Management, please complete the information below. Your report will be mailed to you within two weeks. View a sample diabetes management profile.

All fields are required. We require your daytime phone number for verification and confidentiality reasons.

Name:
Address:
City:
State:	Georgia
ZIP Code:
County:
Office Contact Name:
Daytime Phone Number: