Profile & Credentials

Need help? Contact us at {{whiteLabel.phoneNumber | tel}} or {{whiteLabel.email}} .

PROVIDER{{vendor.vendorType=='DRIVER'?' DETAIL':''}} Profile & Credentials

Credit Card Only

SUSPEND

REVOKE SUSPEND

PROVIDER INFORMATION

{{vendor.phoneNo | tel}} ({{vendor.mobileExtension}}) {{(!vendor.phoneNoHotlink?vendor.phoneNo:'') | tel}} ({{vendor.mobileExtension}})

{{vendor.vendorType | camelCase}} ({{vendor.providerType}})

{{vendor.alternatePhoneNo | tel}}({{vendor.alternatePhoneNoExtension}})

Onboard For Vendor Portal

Is Eligible For PO Confirmation: {{vendor.eligibleForPOConfirmation?'Yes': 'No'}}

Recruiter: {{vendor.recruiter}}

Source: {{vendor.sources}}

SUSPENDED DUE TO: {{vendor.remarkForProviderSuspension? vendor.remarkForProviderSuspension: 'NA'}}

SPECIAL INSTRUCTIONS

PROVIDER DOCUMENTS

Insurance No : {{vendor.insuranceNo}}

Certificate to Drive : {{vendor.driveCertificate}}

Download

Document Type

Expiry Date

Verified

Download

No Provider Document(s) to Show.

Social Security Number : {{vendor.screenNum}}

Federal Tax Classification : {{vendor.federalTaxClassification=='Individual'?'Individual/sole proprietor or single-member LLC': (vendor.federalTaxClassification=='S' || vendor.federalTaxClassification=='C' || vendor.federalTaxClassification=='P')? ('Limited Liability company - '+vendor.federalTaxClassification):vendor.federalTaxClassification}}

PHYSICAL ADDRESS

ADDRESS

{{vendor.streetAddress1}}, {{vendor.streetAddress2}},
{{vendor.cityName}}, {{vendor.stateName}}, {{vendor.zipCode}}

MAILING ADDRESS Same as Physical Address

{{vendor.mailingStreetAddress1}}, {{vendor.mailingStreetAddress2}},
{{vendor.mailingCityName}}, {{vendor.mailingStateName}}, {{vendor.mailingZipCode}}

SERVICEABLE AREA & VEHICLE DETAILS

SERVICEABLE AREA & INTERPRETER DETAILS

Added Serviceable Area

State

City

Zip

Miles

Travel Mile Distance

Added Serviceable Area Vehicles

Vehicle Type	Vehicle Number	$ Per Mile	$ No Show	$ Wait Per Hour	$ Load Fee	$ Min Trip	$ Dead Miles	$ Late Cancellation Fee	$ Other Fee
{{serviceDetail.transportName}}	{{serviceDetail.transportNo?serviceDetail.transportNo:'-'}}	{{serviceDetail.pricePerMile \| number: 2}}	{{serviceDetail.priceNoShow \| number: 2}}	{{serviceDetail.priceWaitPerHour \| number: 2}}	{{serviceDetail.loadFee?serviceDetail.loadFee: '-'}}	{{serviceDetail.minTrip\| number: 2}}	{{serviceDetail.deadMiles\| number: 2}}	{{serviceDetail.lateCancellationFee}}	{{ otherFeeItem.otherPriceDescription }} : {{ otherFeeItem.otherFee \| number:2 }}	-

Interpreter Type

On-Site Interpretation , Telephonic Interpretation , Written Translation

Rate Info

$ Travel Miles

Travel Time

{{interpretationDetails.pricePerMile}} -

{{interpretationDetails.pricePerTime}} -

Added Language -

{{language.language}} ($ {{language.pricePerHour}})

AllLanguage( $ {{servicableArea.interpretationDetails[0].allLanguagePrice}})

Certification -

Court Certified, Medical Certified, Administrative Certified, Qualified (Non-Certified)

Rate Info

$ No Show

Min Hours

$ Cancellation

{{language.noShow}} -

{{language.priceMinHour}} -

{{language.cancellation}} -

RATING INFO

Average Rating :

({{vendor.averageRatingWithPrecision}}) (Total Ratings - {{vendor.patientFeedbacks.length}})

Individual Ratings :

({{feedback.ratingWithPrecision}}) From {{feedback.patientFullname}} for {{feedback.agencyDriverName}} ({{feedback.fileNumber}}) - ({{feedback.dateOfService}})

PROVIDER AUDIT INFORMATION

Created Date : {{vendor.providerCreatedDate}}

Created Time : {{vendor.providerCreatedTime}}

Created By : {{vendor.providerCreatedByUser}} NA

Modified Date : {{vendor.providerUpdatedDate}} NA

Modified Time : {{vendor.providerUpdatedTime}} NA

Modified By : {{vendor.providerUpdatedByUser}} NA

No note to show

Created - {{convertDate(note.noteCreationDate)}} By {{note.creatorName}}

Modified123 - {{convertDate(note.noteModifiedDate)}} By {{note.modifierName}}

EDIT

APPOINTMENT LIST