Get Pif-2 2011

Completing the Principal Information Form (PIF-2) online is a crucial step for individuals and entities seeking enrollment. This guide provides detailed instructions to help users fill out each section of the form accurately and efficiently.

Follow the steps to fill out the PIF-2 online.

1. Click the ‘Get Form’ button to obtain the form and open it in the designated online editor.
2. Identify whether you are a Principal or Subcontractor by checking the corresponding box on the form.
3. Enter your full name, including last name, first name, and middle initial. If applicable, provide your maiden name and any other aliases you may have used.
4. Fill in your physical address, including the number and street. If your accounting or billing address differs, provide that information as well.
5. Indicate your relationship to the accounting address by selecting an option from the list provided, such as 'Billing agent' or 'Self.' If you choose 'Other,' you must explain your relationship.
6. Complete the professional licensing or certification section by including relevant license numbers, issue dates, and expiration dates if applicable.
7. Input your Social Security Number and Federal Tax ID number. Provide information about your specialty of practice and Medicare details if applicable.
8. Provide previous physical and accounting addresses if they differ from the current addresses. Include dates for any previous addresses.
9. Clearly state your title and duties within the provider organization. Use additional sheets if necessary.
10. List all named principals and the relevant entities you have previously billed under, providing their details accurately.
11. Answer all questions regarding sanctions, license status, and criminal convictions truthfully and completely, attaching additional pages as necessary.
12. Finalize the form by reviewing the information entered. Save your changes, and utilize options to download, print, or share the completed PIF-2 form as needed.

Complete your PIF-2 online today for a smooth enrollment process.