Stay up to date with what's happening at Passport and register to receive Passport's eNews communications by completing the below fields.  If you represent multiple tax IDs, please complete the additional Provider Name and Tax ID fields as applicable.  Please allow 7-10 business days after registration to begin receiving eNews communications.  Previously released eNews communications can be found on our website, www.PassportHealthPlan.com, or by clicking here.

Fields marked with an asterisk(*) are required.

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1. First Name (Required.)

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2. Last Name (Required.)

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3. Job Title (Required.)

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4. Provider Name (pay-to/group level) (Required.)

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5. 9-digit Tax ID
Please do not use dashes. See questions 10-18 for multiple TIN affiliations. If you are not affiliated with a TIN please enter 999999999. (Required.)

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6. Email Address (Required.)

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7. Fax # (Required.)

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8. Select the line(s) of business you wish to receive eNews for. (Required.)

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9. Please indicate your provider type(s). (Required.)

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10. Additional Provider Name (2)

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11. Additional Tax ID (2)

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12. Additional Fax # (2)

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13. Additional Provider Name (3)

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14. Additional Tax ID (3)

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15. Additional Fax # (3)

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16. Additional Provider Name (4)

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17. Additional Tax ID (4)

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18. Additional Fax # (4)

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