AMGA Medical Group Application for Membership

How to Join: To join, simply complete this application. For additional information on the benefits of membership please contact Bill Baron at (703) 842-0775, or wbaron@amga.org .

AMGA Medical Group Application for Membership
Name of organization *
Phone *
Fax *
Website *
Address *
City *
State *
Zip Code *
Top Executive:
Name
Title
Email
Top Physician Leader:
Name
Title
Email
Top Operations Leader:
Name
Title
Email

Best person to update organizational information and roster:

Name
Title
E-mail
Organizational Context (i.e., group practice, IPA, IDS, Academic Practice) *
Tax Status (select one) *
Number of Physicians *
Number of Prepaid Enrollees
Number of Employees
Number of Satellite Facilities
Number of Active Patients
Electronic Health Record System
Fiscal Year
Date *
Submitter Name *
Submitter Email *
Submitter Phone *
AMGA Annual Dues Structure

Organizations that Employ Physicans
(Group Practice, IDS, Academic/Faculty Practice)

 

Organizations that Contract
with Physicians (IPA)

 

 # of FTE Physicians                  Dues                                                      # of Enrollees                              Dues

 3   -    50                                   $  6,250                                                    Up to 60,000                              $  6,250

 51   -   150                                $11,250                                                    60,001 -   180,000                      $11,250

151 -    500                                $16,750                                                  180,001 -   600,000                      $16,700

501 -    1,000                             $19,500                                                  600,001 - 1,200,000                     $19,500

1,001 - 1,500                             $26,000                                                 More than 1,200,000                    $26,000

1,501 - 2,000                             $32,000

2,001 - 2,500                             $38,000

2,501 - 3,000                             $44,000

3,001 - 3,500                             $50,000

3,501 - 4,000                             $56,000

4,001 - 4,500                             $62,000

For organizations with more than 4,500 physicians, dues will increase in the same proportioned manner.

 

How to Join: To join, simply complete this application. For additional information on the benefits of membership please contact Bill Baron at (703) 842-0775, or wbaron@amga.org .




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AMGA | One Prince Street, Alexandria, VA 22314-3318
(703) 838-0033 phone (703) 548-1890 fax
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