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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 npi information form

01

Start by gathering all the required information such as your personal details, contact information, and professional credentials.

02

Visit the official NPI (National Provider Identifier) website to access the online form.

03

Fill in the necessary fields with accurate and up-to-date information.

04

Provide your legal name, business name, or individual name associated with the NPI.

05

Include your practice location address and contact details.

06

Specify your business structure and taxonomy code.

07

Mention your healthcare provider type and the specific services you offer.

08

Enter your license information, including the issuing state and license number.

09

Supply your business or individual NPI enumeration date.

10

Review the form thoroughly to ensure all the information is correct.

11

Submit the completed form online or follow alternative instructions provided by the NPI website.

12

Keep a copy of the confirmation or receipt for your records.

Who needs npi information form?

01

Healthcare providers such as doctors, dentists, nurses, therapists, and other medical professionals.

02

Healthcare organizations such as hospitals, clinics, pharmacies, and nursing homes.

03

Medical billing companies and clearinghouses involved in processing healthcare claims.

04

Any entity or individual involved in the electronic exchange of health information.

05

Entities or individuals seeking to bill Medicare, Medicaid, or private insurance companies.

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What is npi information form?

NPI information form is a form used to collect and report National Provider Identifier (NPI) information for healthcare providers.

Who is required to file npi information form?

Healthcare providers who are eligible for an NPI number are required to file the NPI information form.

How to fill out npi information form?

To fill out the NPI information form, healthcare providers need to provide their personal information, practice details, and NPI number.

What is the purpose of npi information form?

The purpose of the NPI information form is to collect and report accurate NPI information for healthcare providers.

What information must be reported on npi information form?

The NPI information form requires healthcare providers to report their personal information, practice details, and NPI number.

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