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MULTI-FACTOR AUTHENTICATION (MFA)
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PROVIDER
PROVIDER
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INTRODUCTION
Individual Providers
Organizations
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INDIVIDUAL PROVIDER PROFILE PAGE
Provider Name Information
Other Name (if Applicable)
Other Identifying Information
Provider Profile Page Navigation
ORGANIZATIONAL PROVIDER PROFILE PAGE
Employer Identification Number (EIN)
Organization Name (Legal Business Name)
Is the Organization a subpart?
Other Name
Authorized Official For the Organization
ADDRESS PAGE
Business Mailing Address
Practice Location Address
Address Page Navigation
Business Mailing Address Window
Practice Location Address Window
HEALTH INFORMATION EXCHANGE (HIE) PAGE
ENDPOINT (Optional)
Health Information Exchange (HIE) Page Navigation
OTHER IDENTIFIERS PAGE
Other Identifiers (optional)
Other Identifier Page Navigation
TAXONOMY PAGE
Practice Type
Taxonomy Code Search Box
Provider Type Code
Taxonomy Page Navigation
CONTACT INFORMATION PAGE
Contact Person Information
Contact Information Navigation
ERROR CHECK PAGE
Error Check
Error Check Page Navigation
SUBMISSION PAGE
Submission Certification
Penalties for Falsifying Information
Submission Certification page Navigation
SUBMISSION CONFIRMATION PAGE
Submission Confirmation for a Type 1 NPI
Submission Confirmation for a Type 2 NPI
Submission Confirmation Page Navigation