Provider Index > Ambulatory Surgery Centers (ASC)
If you are licensed to and DO prescribe, administer, or dispense controlled substances, you are required to complete only Sections A and C. If you are licensed to but do NOT prescribe, administer, or dispense controlled substances, you are only required to complete only Sections A and B.
If you do NOT prescribe, administer, or dispense controlled substances, then you do NOT need to submit a DEA certificate. You must, however, complete and submit the DEA Form (EMEDNY #610301) found below.
If you DO prescribe, administer, or dispense controlled substances, then you must submit a copy of your DEA certificate or a web-based printout from the Office of diversion Control website at https://www.deadiversion.usdoj.gov/webforms/dupeCertLogin.jsp and complete the DEA Form (EMEDNY #610301). If employed by an institution and authorized to use the institution’s DEA, you must submit a copy of the institution’s DEA certificate and proof of the suffix/identifier assigned to you by the institution.