Get the free National Provider Identifier (NPI) Submission Form

Name: Fillable Online NPI Submission Form for Individual – Type 1 Providers Fax Email Print - pdfFiller
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This form is used to collect necessary information from individual providers for the submission of their National Provider Identifier (NPI) to BCBSNM.

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How to fill out national provider identifier npi

How to fill out National Provider Identifier (NPI) Submission Form

01

Obtain a copy of the National Provider Identifier (NPI) Submission Form from the official NPI website.

02

Fill in the required personal information, including your legal name and any business name if applicable.

03

Provide your Social Security Number (SSN) or Employer Identification Number (EIN).

04

Specify your practice location, including the address and contact information.

05

Indicate your taxonomy code(s) that represent your specialty or the services you provide.

06

Fill out the questions related to enrollment in Medicare and Medicaid, if applicable.

07

Review the form for accuracy and completeness.

08

Submit the form online or print it out and mail it to the designated NPI Enumerator.

Who needs National Provider Identifier (NPI) Submission Form?

01

Healthcare providers such as physicians, nurses, and pharmacists.

02

Organizations such as hospitals, clinics, and group practices.

03

Any individual or entity that bill for healthcare services or supplies.

04

Healthcare professionals who want to participate in Medicare and Medicaid programs.

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What is National Provider Identifier (NPI) Submission Form?

The National Provider Identifier (NPI) Submission Form is a document used by healthcare providers to apply for a unique identification number issued by the Centers for Medicare & Medicaid Services (CMS). This number is used to identify healthcare providers in standard transactions.

Who is required to file National Provider Identifier (NPI) Submission Form?

Any healthcare provider who wishes to bill for services provided to patients, including physicians, nurses, dentists, and pharmacists, must file the NPI Submission Form to obtain an NPI.

How to fill out National Provider Identifier (NPI) Submission Form?

To fill out the NPI Submission Form, providers need to provide personal and professional information, including their name, date of birth, social security number, and business information if applicable. The form can be submitted online through the National Plan and Provider Enumeration System (NPPES) website.

What is the purpose of National Provider Identifier (NPI) Submission Form?

The purpose of the NPI Submission Form is to collect essential information from healthcare providers so that they can be assigned a unique NPI, which helps streamline billing and improves communication within the healthcare system.

What information must be reported on National Provider Identifier (NPI) Submission Form?

The information required on the NPI Submission Form includes the provider's legal name, business address, phone number, tax identification number, and type of healthcare service provided. Additional information regarding practice location and specialties may also be required.

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