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NPI Submissions

Use this form to submit National Provider Identifiers (NPIs) to us. The NPI is a 10-digit number issued by the Centers for Medicare & Medicaid Services. Once assigned, an NPI is permanent and remains with the provider. An NPI must be used in HIPAA standard transactions.

If you need to submit NPIs for six or more providers, we will send you a submission spreadsheet to fill out and return.

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 provider NPIs being submitting and then enter the required information for each provider below.

Provider 1

*Entity type

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

A 9 digit number is required. Please do not include spaces or dashes.

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Name (individual/organization)

Primary service location information

Primary billing location information

NPI information

A 10 digit number must be entered. The first digit must be a 1.

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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