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NPI Submissions

Use this form if you are submitting NPIs for five or fewer providers. 
Request the NPI submission spreadsheet if you are submitting NPIs for six or more providers.

All fields marked with a RED asterisk (*) are required in order to proceed.

*Choices for submitting NPIs
Contact Information
NPI Information

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

Provider 1
*Entity Type

Name (individual/organization)

Primary service location information

Primary billing location information

NPI information

NPI usage (how are your 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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