ERROR: Submission
{{Data.NppesMsgs.TERMS_ERROR}}
After reading the terms and conditions listed below, check the box at the bottom of this page then click “Submit” to submit your application.
-
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
of this fact 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:
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.