PROVIDER

• 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