ORGANIZATIONAL PROVIDER PROFILE PAGE

The Organizational Provider Profile page captures the organization profile information associated with a Type 2 NPI.

Employer Identification Number (EIN)

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that employers have standard national numbers that identify them on standard transactions. The Employer Identification Number (EIN) is issued by the Internal Revenue Service (IRS).to identify a business entity. SSNs should never be reported in the EIN field.

Is the Organization a subpart? :

You are required to identify whether or not the organization is a subpart. If the organization is subpart of another organization then select the radio button ‘Yes’. If the organization is not a subpart of another organization then select a radio button that indicates as ‘No’.

Is the parent EIN the same as the subpart EIN?

If you selected ‘Yes’ indicating the Provider Organization is a subpart, the system will ask you if the Provider Organization’s EIN is the same as the Parent Organization’s EIN. Select ‘Yes’ if the EINs are the same, or select ‘No’ if the EINs are different.

Parent Organization EIN:

If you selected ‘No’ indicating the Parent EIN is different from the Provider Organization, you will be required to enter the Parent EIN.

Parent Organization LBN:

If you selected ‘No’ indicating the Parent EIN is different from the Provider Organization, you will be required to enter the Parent Organization’s Legal Business Name (LBN). If the Parent EIN is already in NPPES, you will have the ability to select the appropriate LBN from a dropdown list. If the Parent EIN is not in NPPES, you will be required to enter the Parent Organization’s LBN.

Other Name:

If your organization uses, or previously used another name, supply those other names here. This information is not required. You have the ability to enter one or more Other Names.

Type of Other Name:

Select the ‘Type of Other Name’ dropdown list. You can select from the following three options. * Doing Business As * Former Legal Business Name * Other Name

Other Organization Name:

Enter the Other Name(s) by which the Provider Organization is known as.

Organizational Other Names Grid and Navigation Buttons

The following are the navigation buttons associated with the Other Name section: Clear Button: Upon selecting the ‘Clear’ button the information populated in the Other Name fields will be cleared. Save Button: Upon selecting the ‘Save’ button information populated in the Other Name fields will be saved to the Grid.

Authorized Official For the Organization:

Provide the full legal name of the Authorized Official for the Organization. An Authorized Official is an appointed official with the legal authority to make changes and/or updates to the provider’s status (e.g., change of address, etc.) and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier. The authorized official must be a general partner, chairman of the board, chief financial officer, chief executive officer, direct owner of 5 percent or more of the provider being enumerated, or must hold a position of similar status and authority within the provider organization.

Authorized Officials Name and other details:

Prefix:
Select the appropriate name prefix from the dropdown list.
  • Dr.
  • Miss
  • Mr.
  • Mrs.
  • Ms.
  • Prof.
First Name:
Provide the First name of the Authorized Official. This is a mandatory field.
Middle Name:
Provide the Middle Name of the Authorized Official. This field is optional.
Last Name:
Provide the Last Name of the Authorized Official. This is a mandatory field.
Suffix:
Select the Authorized Official’s name suffix from the dropdown list, if applicable.
  • I
  • II
  • III
  • IV
  • V
  • VI
  • VII
  • VIII
  • IX
  • X
  • Jr.
  • Sr.
Credential(s): (M.D, D.O, etc.)
Providing the Authorized Official’s credentials is optional.
Title/Position:
Provide the Title and or Position of the Authorized Official of the Organization. This is a mandatory field.
Telephone Number:
Provide the Telephone Number. This is a mandatory field.
Extension:
Provide Telephone Number Extension, if applicable.

Organization Profile Page Navigation:

Next Button: Upon selecting the ‘Next’ button you will be navigated to the next NPI application page.

Save & Return to Main Page Button: Upon selecting the ‘Save and Return to Main Page’ button, you will be navigated to the Main page.