Get Npi Submission Form Organizational Provider ... - Valueoptions

This guide provides detailed instructions on how to complete the NPI Submission Form for Organizational Providers with ValueOptions. By following the steps outlined in this guide, users will be able to fill out the form with confidence and accuracy.

Follow the steps to successfully complete the NPI Submission Form.

1. Press the ‘Get Form’ button to obtain the NPI Submission Form and open it in your editing tool.
2. Begin by filling out Section 1 – Basic Information. Indicate the reason for submitting the form by checking the appropriate box: Initial Submission, Change of Information, Deactivation of NPI, Death, Business Dissolved, or Other. Ensure to provide your NPI number if applicable.
3. Move to Section 2 – Organizations and Groups. Enter the Legal Business Name and any other names under which your organization operates, such as Former Legal Business Name, D/B/A Name, or any other name.
4. In Section 3 – Address and Other Information, provide the mailing address details including Street Number and Name or P.O. Box, Suite Number (if applicable), City, State, Zip + 4 or Foreign Postal Code, Country Name, Telephone Number, Fax Number, and Email address.
5. Complete the Other Provider Identification Numbers section if your organization has them. Enter different number types like UPIN/Medicare, Medicaid, or any other as applicable.
6. For organizations considering a Single NPI or Multiple NPIs, navigate to Section 4 if Single and Section 5 if Multiple. Fill in the relevant details as required for Single NPIs or list each service location in Multiple NPIs accordingly.
7. If you selected Single NPI, enter the Single NPI number, TIN associated with the NPI, and the Provider Taxonomy Code along with the License Number information.
8. If you selected Multiple NPIs, fill in all necessary categories and locations, including Service and Billing Location addresses, Licenses, Programs, and CMS Provider Types or Specialties.
9. In Section 6 – Organization Signature, ensure that a signing authority in your organization completes and dates the section with their full name.
10. Review all entered information for accuracy and completeness. Once finalized, you can save changes, download, print, or share the completed form as needed.

Complete your NPI Submission Form online today for smooth processing.