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NPI Application Instructions

Note: Use of Back and Forward browser buttons could result in loss of all the information entered. Users should use the Next and Previous buttons provided on the application to navigate between the pages of the application.

 

Step 1:

Before you begin, make sure you have the following information.
  This information will be required to complete the NPI Application Form.
You will not be able to save your work if you quit before you have completed the application form.
  • Information Required for Individual Providers
    Provider Name
    SSN (or ITIN if not eligible for SSN) 2
    Provider Date of Birth
    Country of Birth
    State of Birth(if Country of Birth is U.S.)
    Provider Gender
    Mailing Address
    Practice Location Address and Phone Number
    Taxonomy (Provider Type) 4
    State License Information 1
    Contact Person Name
    Contact Person Phone Number and E-mail
  • Information Required for Organizations
    Organization Name
    Employer Identification Number (EIN) 3
    Name of Authorized Official for the Organization
    Phone Number of Authorized Official for the Organization
    Organization Mailing Address
    Practice Location Address and Phone Number
    Taxonomy (Provider Type) 4
    Contact Person Name
    Contact Person Phone Number and E-mail
  1 (required for certain taxonomies only)
2 (SSN or ITIN information should only be reported in the SSN or ITIN field)
3 Do not report an SSN or IRS ITIN in the EIN field
4 Provider Taxonomy codes can be obtained from http://www.wpc-edi.com/codes/taxonomy

Online Help is available from each page of the Application / Update Form by clicking "Help" at the top right of the page.

If you need additional help or have any questions concerning your application, contact the NPI Enumerator.

NPI Enumerator Contact Information
By phone: By e-mail at: By mail at:
1-800-465-3203 (NPI Toll-Free)
1-800-692-2326 (NPI TTY)
customerservice@npienumerator.com NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059

 

Step 2: Certification Statement: Read and Certify.


*

  • I have read the contents of the application and the information contained herein is true, correct, and complete. If I become aware that any information in this application is not true, correct, or complete, I agree to notify the NPI Enumerator immediately.

  • I authorize the NPI Enumerator to verify the information contained herein. I agree to keep the NPPES updated with any changes to data listed on this application form within 30 days of the effective date of the change.

  • I have read and understand the Privacy Act Statement.

  • I have read and understand the Penalties for Falsifying Information on the NPI Application / Update Form as stated in this application. I am aware that falsifying information will result in fines and/or imprisonment.


Penalties for Falsifying Information on the NPI Application / Update Form:
18 U.S.C. 1001 authorizes criminal penalties against an individual who in any matter within the jurisdiction of any department or agency of the United States knowingly or willfully falsifies, conceals, or covers up by any trick, scheme or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry. Individual offenders are subject to fines of up to $250,000 and imprisonment for up to five years. Offenders that are organizations are subject to fines of up to $500,000. 18 U.S.C. 3571(d) also authorizes fines of up to twice the gross gain derived by the offender if it is greater than the amount specifically authorized by the sentencing statute.
 

Step 3: Begin online application.