WIM Custom Query/Mailing List Request Form

Thank you for your interest in a custom query by WIM. Complete this form to tell us what data you need and how it will be used. Once the request is submitted, we will build a query and provide you with a quote for the cost of the spreadsheet (via email). Most quotes are prepared within 6 hours, but please allow for up to 2 business days under certain circumstances.

The cost of the query depends on the section of providers you are requesting. See current fee schedule here. Once you agree to the quote, we will send you an invoice via Quickbooks that can be paid online or over the phone. Upon receipt of the payment, we will email you the spreadsheet.

Your spreadsheet may be identified or de-identified. Identified lists include provider name, de-identified lists do not. All lists will include the following fields. Only Montana providers are currently available via custom query.

  • Provider Specialty (Family Medicine, Internal Medicine, etc.)
  • Provider License Type (Physician, APRN, PA, etc.)
  • Location Status (Primary or Secondary)
  • Practice Address
  • Practice City
  • Practice State
  • Practice Zip
  • Practice County
  • Mailing Address
  • Mailing City
  • Mailing State
  • Mailing Zip

Data can be geocoded for an additional fee.

Click here to load this Caspio Online Database.