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Get Cms-10114 2018-2025
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How to fill out the CMS-10114 online
The CMS-10114 form is essential for health care providers seeking to obtain or update their National Provider Identifier (NPI). This guide offers clear, step-by-step instructions on how to complete this form online, ensuring accurate and efficient processing.
Follow the steps to complete the CMS-10114 online effectively.
- Click the ‘Get Form’ button to access the CMS-10114 online, where you can begin filling it out.
- In Section 1, select the reason for submitting the form: Initial Application, Change of Information, Deactivation, or Reactivation. Ensure you check the appropriate box and provide any required details.
- In Section 1B, choose the entity type by checking either 'Entity Type 1' for individuals or 'Entity Type 2' for organizations. Only select one option.
- Proceed to Section 2, where you will provide identifying information. For individuals, fill out your full legal name, date of birth, gender, and if applicable, additional names. For organizations, provide the legal business name and Employer Identification Number (EIN).
- In Section 3, input your correspondence mailing address and business practice location. This information must be complete to facilitate contact regarding your application.
- Fill out any additional provider identification numbers and taxonomy codes in Section 3C and 3D if applicable, ensuring the details are accurate.
- In Section 4, sign the certification statement. This requires the signature of the individual for Type 1 or the authorized official for Type 2 organizations. Be sure to include the date.
- Finally, provide contact information in Section 5 for a person who can answer questions related to your application. This ensures that any inquiries can be directed to the appropriate individual.
- Once the form is completed, review all entries for accuracy before submitting. You can save changes, download a copy, print, or share the form as needed.
Follow these instructions to complete your CMS-10114 online and ensure efficient processing of your application.
To update your NPI information online, visit the NPPES website and log into your account. It is essential to provide accurate and complete details to ensure compliance with CMS-10114 standards. If you need assistance with the process, USLegalForms offers solutions to simplify and streamline your updates.
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