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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 comprehensive, step-by-step instructions to help users easily navigate and complete the application online.
Follow the steps to fill out the CMS-10114 form effectively.
- Press the ‘Get Form’ button to access the CMS-10114 form and open it in the appropriate format for completion.
- In Section 1, provide your basic information. Select the reason for submitting the form: whether it is an initial application, a change of information, deactivation, or reactivation. Make sure to check the relevant box and include any necessary identifiers.
- Proceed to Section 2 to fill out identifying information. For individuals, enter your full legal name as well as any credentials. If you have additional names or credentials, use extra sheets if necessary. For organizations, enter the legal business name and the Employer Identification Number (EIN).
- In Section 3, provide business addresses. Include your business mailing address and practice location information, ensuring to use a non-residential address unless it is applicable.
- If applicable, list other provider identification numbers in Section 3. This helps facilitate matching your NPI with existing health plans.
- Complete Section 4, the certification statement. Ensure the appropriate individual or authorized official signs and dates this section to verify that the information provided is accurate.
- In Section 5, identify a contact person who can address any questions regarding the application. Fill out the person's name and telephone number.
- After completing all sections, save any changes made to the form. You can then download, print, or share the completed CMS-10114.
Complete the CMS-10114 online to ensure a smooth application process for your National Provider Identifier.
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CMS disclosure must be filed by various healthcare providers, including physicians, practitioners, and suppliers who are part of the Medicare program. This disclosure is essential if you have ownership or control interests that meet specific criteria. To ensure compliance with CMS-10114, check the CMS guidelines relevant to your field. Utilizing platforms like uslegalforms can streamline your understanding of these requirements.
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