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FAX COVER SHEET NPI Information Form Date: To: Page 1 of pages Provider Information Unit Fax: (808) 9486887 HSA Provider Services Phone (808) 9485190 From: Phone: Fax: NPI Information Form and supporting
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How to fill out the NPI information form cover:

01
Start by obtaining the necessary form from the National Plan and Provider Enumeration System (NPPES) website or any authorized provider.
02
Carefully review the instructions provided with the form to ensure you understand all the required information.
03
Begin by filling out your personal information, including your full name, contact details, and professional credentials.
04
Provide your National Provider Identifier (NPI) number, if you have one already. If not, leave this section blank and the NPI will be assigned to you upon submission.
05
Enter your business or practice information, such as the name, address, and phone number.
06
Indicate your practice type (individual provider, organization, or sole proprietor) and specify any additional details if necessary.
07
If applicable, provide your taxonomy code, which helps classify the type of healthcare services you provide.
08
Next, outline your practice location details, including the physical address and mailing address, if different.
09
Fill out the additional contact information section, including your email address and any preferred modes of contact.
10
Sign and date the form to certify the accuracy of the information provided.
11
Review the completed form to ensure all sections are properly filled out and there are no errors or omissions.
12
Keep a copy of the filled form for your records.
13
Submit the form via mail or electronically, following the instructions provided.

Who needs the NPI information form cover:

01
Healthcare providers such as physicians, dentists, psychologists, therapists, and other medical practitioners who bill Medicare, Medicaid, or private insurance companies for their services.
02
Organizations or group practices that employ healthcare providers and bill for their services.
03
Sole proprietors operating a healthcare practice on their own.
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The NPI information form cover is a document that contains information about a healthcare provider's National Provider Identifier.
Healthcare providers who are eligible for an NPI are required to file the NPI information form cover.
The NPI information form cover can be filled out by providing the required information about the healthcare provider's NPI.
The purpose of the NPI information form cover is to provide accurate information about a healthcare provider's NPI.
The NPI information form cover must report the healthcare provider's NPI, name, and contact information.
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