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/NGA Staff Code L.E. Name: FFS Ind Prov No. FFS Individual SSN (Last 4 only) FFS Group FFS Org Tax Payer ID (FFS only) Language Code Contact & Assigned Location Information Contact name: Contact phone no: ( Contact Email: ) Contact Fax No: ( ) Add this rendering provider in the service location indicated below: (please use form MH-228A for additional locations) Delete this rendering provider in the service location indicated below. Delete this rendering provider in ALL service locati.

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Related content

Rendering Provider Form - Los Angeles County
Mar 19, 2007 — The Rendering Provider Form must be completed for all clinical staff...
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Massachusetts Behavioral Health
DMH case management services of Care Management Services - shall mean mental health Case...
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Vermont Medicaid Provider Manual VTMedicaid...
126 12.4.13 Outpatient Services Rendered During an Inpatient Stay . ... Note: Provider...
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Related links form

NY DTF ST-120.1 2009 NY DTF ST-120.1 2006 NY DTF ST-121 2011 NY DTF ST-121 2010

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Render is a synonym of make — technically it means "cause to become." An illness might render you unable to walk, or a shocking sight might render you speechless.

The rendering provider NPI is the individual NPI of the provider who performed the services on the patient being billed. The billing provider NPI is the NPI of the person or entity that should be paid for the services.

o When the rendering provider is the same entity as the billing provider, the rendering provider should be omitted. o Rendering providers must be an individual provider and should be billed with the individual NPI and taxonomy. o The referring provider should not be the same as the rendering provider.

• Rendering Provider o When the rendering provider is the same entity as the billing provider, the rendering provider should be omitted. o Rendering providers must be an individual provider and should be billed with the individual NPI and taxonomy.

A Rendering/Servicing provider is one who provides services through a Group, Facility, Agency, Organization or an Individual/Sole Proprietor.

Rendering provider means an individual, facility, institution, corporate entity, or other organization that supplies health services or items, also termed a provider, or bills, obligates, and receives reimbursement on behalf of a provider of services, also termed a billing provider (BP).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232