Get Ndoi 901 R

This guide provides a clear and concise overview of how to fill out the Ndoi 901 R form online. It includes detailed instructions for each section to assist users, including those with little legal experience, in successfully completing the form.

Follow the steps to complete your Ndoi 901 R form online.

1. Click the ‘Get Form’ button to access the Ndoi 901 R form and load it into your editor of choice.
2. Begin with the personal data section. Enter your name, date of birth, social security number, and specialty accurately.
3. Provide your local residence address and phone number. Ensure that all information is correct.
4. Fill in your primary office information, including address, phone, and fax numbers, as well as email and cell phone details.
5. Complete the credentialing section, including your UPIN, Medicare and Medicaid numbers, and tax ID and NPI numbers.
6. Indicate any foreign languages you speak and other languages spoken in your office.
7. List your hospital and healthcare entity memberships from the past three years, including any explanations for applications withdrawn or affiliations terminated.
8. If applicable, provide information regarding peer recommendations, ensuring to adhere to the criteria given.
9. Complete the malpractice insurance section, detailing all carriers and ensuring to attach copies of current coverages.
10. Address the practitioner questionnaire thoroughly, providing details where you respond positively.
11. Make sure to review your application for accuracy. Cross out any incorrect information and replace it with the correct details.
12. Once completed, save your changes, then download or print the form to retain a copy for your records.
13. You may share or fax your application and relevant documents, ensuring you follow up to confirm receipt.

Start filling out your Ndoi 901 R form online today for successful credentialing.