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Use this form to submit your NPI. Please complete a separate form for each payer to the payers listed below. Blue Cross and Blue Shield of Minnesota, BC BSM PDO, R3-19, PO Box 64560, St. Paul, MN
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How to fill out providerorganization NPI submission form:

01
Start by gathering all the necessary information and documents required for the form. This may include your personal details, business information, and legal documentation.
02
Carefully read and understand the instructions provided on the form. Make sure you comprehend all the requirements and sections that need to be completed.
03
Begin filling out the form by entering your personal information, such as your full name, date of birth, social security number, and contact details.
04
Provide the required details about your organization, including the name, address, phone number, and type of practice.
05
Indicate the type of healthcare services your organization provides, as well as any specialties or areas of focus.
06
If applicable, fill in the details of any additional individuals associated with your organization, such as partners or board members.
07
Double-check all the entered information to ensure accuracy and completeness. Mistakes or missing information may result in delays or rejections.
08
Sign and date the form in the designated space to confirm the accuracy and validity of the provided information.
09
Make a copy of the completed form for your records before submitting it to the appropriate authority.

Who needs providerorganization NPI submission form:

01
Healthcare providers, such as doctors, nurses, dentists, and therapists, who work independently or have their own practice, will need to fill out the providerorganization NPI submission form.
02
Healthcare facilities, including hospitals, clinics, and nursing homes, may also need to complete this form to obtain a National Provider Identifier (NPI) for their organization.
03
Medical billing companies or medical billing departments within healthcare organizations might require this form to properly identify and bill for services rendered.
It is important to note that the specific requirements for the providerorganization NPI submission form may vary depending on the country or region, so it is advisable to check with the relevant regulatory authority for detailed instructions.
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The providerorganization NPI submission form is a form used to submit National Provider Identifier (NPI) information for healthcare providers and organizations.
Healthcare providers and organizations are required to file the providerorganization NPI submission form.
The providerorganization NPI submission form can be filled out online or through paper submission with the required NPI information.
The purpose of the providerorganization NPI submission form is to ensure accurate and up-to-date NPI information for healthcare providers and organizations.
The providerorganization NPI submission form must include information such as provider or organization name, address, contact information, and NPI number.
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Related Links

MAIN PAGE — NPPES Documentation
Apply for a Type 1 individual Provider NPI or Type 2 Organization NPI. ... If the provider has more than one NPI application, select the file icon in the ...
I&A Help Topics
An Authorized Official is the user who is responsible for establishing the provider organization in the I&A system and submitting the organization's CP575 form or ...
NPPES NPI Registry
The NPI Registry Public Search is a free directory of all active National Provider Identifier (NPI) records. Healthcare providers acquire their unique ...

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