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Member Benefits


Educating Medical Directors from
Employers, Health Plans and Provider Systems
 

  
 

NAMCP Individual Physician Application
Individual membership is for a physician medical director
 from an employer, health plan or provider system
 

  

   

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Application Type:  New    Renewal
Name:
Credentials: MD  DO  
Specialty:
Title:
Company:
Street:
City:
State:
Zip Code:
 Office Phone:
Cell Phone:
Fax:
Email:
Referred By:
Your Responsibility within
your organization:		 Medical Director
 Disease Management/QA/QI
 Utilization Management/Review
 P&T Chair
 P&T Member
 
Your organization has the following mix: % Commercial
 % Medicare
 % Medicaid
 
Type of employer: Employer
  Health Plan
  Provider System, Medical Group, IPA, PHO, ACO etc
   

Payment:

    

If Paying by Credit Card:  

I am a Physician - $149
 I am a Resident or Student - $25*
*applicable during primary residency only

 When you hit submit, you will be taken to a page where you can input your credit card information.

If you are paying by credit card and the cardholder name is different than applicant name above,
please enter cardholder name here:
 

  
If Paying by Check, Check #::
NAMCP Medical Director Institute
4435 Waterfront Drive, Suite 101, PO Box 4765
Glen Allen, Virginia 23058-4765
When you provide a check as payment, you authorize us either to use information from your check to make a one-time
electronic fund transfer from your account or to process the payment as a check transaction.
Federal I.D.# 54-1566359
Please Send Receipt by: Email from above

 Email to
 

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For Additional Information

Phone: (804)-527-1905
Fax: (804)-747-5316
email:

NAMCP
4435 Waterfront Drive, Suite 101, PO Box 4765
Glen Allen, Virginia 23058-4765

Federal I.D.# 54-1566359

A nonprofit 501(c)6 association
Membership dues are not deductible for
federal income tax purposes but may be
deductible as a business expense. Consult
your tax advisor for more information.
Copyright © 2011 NAMCP. All rights reserved.
Revised: June 16, 2022.

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