Get Provider & Organizational Npi Notification Form

Completing the Provider & Organizational NPI Notification Form online is essential for health care providers and organizations to ensure accurate National Provider Identifier registration. This guide provides clear, step-by-step instructions to assist you in filling out the form accurately and efficiently.

Follow the steps to complete the form seamlessly.

1. Click ‘Get Form’ button to obtain the form and open it in your document editor.
2. Select the type of NPI you are applying for: Individual, Organization, or Subpart of an Organization. This choice will determine the specific sections of the form you need to fill out.
3. If you are completing Section 1 for Individual NPI Information, provide your last name, first name, and middle initial. Also, include your BCBSKS Billing Provider Number, NPI, and Employer Identification Number (EIN). Fill in your address, indicating whether you are incorporated, and provide your Social Security Number and taxonomy.
4. For Section 2, the Organization NPI Information, enter the 'doing business as' name along with the official practice or organization name. Similar to Section 1, include your EIN and address. Indicate whether your organization is incorporated and provide the NPI and taxonomy details.
5. You must confirm whether the organization has subparts. If yes, complete Section 3. Input the relevant subpart information, which includes the same details as in Section 2, such as EIN, incorporation status, and NPI.
6. Review the form for accuracy, ensuring that all fields are filled out properly. Once confirmed, you can save your changes, download a copy, print the form, or share it as needed.

Complete your Provider & Organizational NPI Notification Form online today for timely processing.