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How to fill out the CMS-10114 online
Filling out the CMS-10114 form for the National Provider Identifier (NPI) application or update can be straightforward if you follow the right steps. This guide provides detailed instructions to help you complete the form accurately and efficiently.
Follow the steps to effectively complete the CMS-10114 form online.
- Press the ‘Get Form’ button to access the CMS-10114 form and open it in your preferred editor.
- Identify the reason for submitting the form in Section 1. Check the appropriate box for either 'Initial Application,' 'Change of Information,' or 'Deactivation' based on your situation.
- In Section 1B, select the entity type that applies to you. You can choose between being an individual who provides health care or an organization delivering health services.
- Move to Section 2, where you will need to provide your identifying information. For individuals, ensure you fill out all fields for your name, date of birth, gender, and Social Security number accurately.
- For organizations, complete the organization name and Employer Identification Number in Section 2B. If applicable, provide any other names previously used.
- Proceed to Section 3 to provide your mailing and practice location addresses. Ensure that the addresses are complete and accurate to ensure proper communication.
- In Section 4, read and understand the certification statement. Sign and date the form as either the individual applicant or an authorized official if representing an organization.
- Lastly, complete Section 5 by providing contact information for someone who can answer questions about your application. Use the same person identified in Section 2A or 4B to save time if applicable.
- Once you have filled out all sections accordingly, review the form for completeness. You can save changes, download, print, or share the completed form as needed.
Complete your CMS-10114 form online today for a smooth application process.
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To fill out a medical authorization form, clearly provide your name, date of birth, and details about the information to be shared. Indicate the person or entity authorized to access your medical records. Using a CMS-10114 compliant form can enhance clarity and ensure proper authorization procedures are followed.
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