Supplier Registration | Lymphedema Educational & Awareness Project

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Supplier Login / Register

Supplier Login / Register

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About Lymphedema
- Diagnosis & Treatment
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Supplier Directory

About Us
- Leadership Team
- Contact Us
About Lymphedema
- Diagnosis & Treatment
- Finding Care & Patient Resources
Resources
- Educational Materials & Handouts
- Physician Education
How You Can Help
- Make a Donation
- Join the Lymphedema Advocacy Group
Supplier Directory

Supplier Registration

Information Disclosure Agreement: The information you are providing will be used to add the below business(es) to our Lymphedema Supplier Directory. I attest that I am authorized to submit this information on behalf of my business or my employer, and that all of the information provided is accurate and current as of the time of this submission. We reserve the right to remove any supplier from the directory, and likewise, a supplier can ask to be removed from the directory at any time.

NOTE: if your business has multiple physical locations please complete the required questions for the first address, and once finished you will have the option to add additional locations.
- I understand and acknowledge the above terms.

Personal Information
First Name*
Last Name*
Email Address*
Title/Position*
Secondary Contact First Name
Secondary Contact Last Name
Secondary Contact Email Address
Secondary Contact Title/Position

Listing Information

Business Name*
Provider NPI number*
Service Areas*
- Local/regional in-person only
- Nationwide by mail only
- Local/regional in-person & nationwide by mail
Street Address*
Business State*
Business City*
Business Zipcode*
Business Website
Business Phone*
Business Email
What lymphedema treatment items do you sell?*
- Standard-fit daytime compression garments
- Standard-fit compression wraps with adjustable straps
- Custom-fit compression wraps with adjustable straps
- Standard-fit nighttime compression garments
- Custom-fit nighttime compression garments
- Compression bandaging supplies
- Custom-fit daytime compression garments
- Basic lymphedema compression pumps
- Advanced lymphedema compression pumps
- Supplies such as donning and doffing aides, gloves, etc.
What parts of the body do you sell treatment items for?*
- Arms / Hands
- Legs / Feet
- Torso / Chest
- Head / Neck
- Pelvic Region
How would you describe your business's experience with lymphedema compression products?*
- Extensive experience
- Moderate experience
- Limited experience
- New to this area
Measuring and Fitting Services*
- Garment measurements must be taken by our staff
- Garment measurements must be submitted by the patient’s therapist or a certified fitter
- Garment measurement can either by taken by our staff or submitted by the patient’s therapist or a certified fitter
What types of insurance do you accept?*
- Medicare (traditional/fee-for-service)
- Medicare Advantage
- Medicaid (traditional/fee-for-service)
- Medicaid Managed Care
- Private Insurance
- Other
- We do not accept/bill any insurance plans
What is your Medicare DMEPOS supplier enrollment status?*
- Participating
- Non-participating

Add Another Location

Information Accuracy*
- I acknowledge that this information is accurate and up to date.

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About Us
- Leadership Team
- Contact Us
About Lymphedema
- Diagnosis & Treatment
- Finding Care & Patient Resources
Resources
- Educational Materials & Handouts
- Physician Education
How You Can Help
- Make a Donation
- Join the Lymphedema Advocacy Group
Supplier Directory

About Us
- Leadership Team
- Contact Us
About Lymphedema
- Diagnosis & Treatment
- Finding Care & Patient Resources
Resources
- Educational Materials & Handouts
- Physician Education
How You Can Help
- Make a Donation
- Join the Lymphedema Advocacy Group
Supplier Directory