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NPI Submissions

All fields marked with a RED asterisk (*) are required.

*Choose an option for submitting National Provider Identifiers (NPIs)

Contact Information

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NPI Information

Please select the number of NPIs and enter the required information for each below.

Provider 1

*Entity type

Please select Social Security Number ONLY if you do not have an Employer ID Number.

Please do not include spaces or dashes.

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Name (individual/organization)


Primary service location information


Primary billing location information


NPI information

The first digit must be a one


NPI usage (how are you using this NPI)
*Does this NPI apply to all providers using this Tax ID?
*Does this NPI apply to all Tax IDs for this provider only?
*Does this NPI apply to all service locations and billing addresses for this Tax ID?
*Does this NPI apply to all service locations and billing addresses for this provider only?

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