Npiregistry.orgwp-contentuploadsNorth Dakota Medicaid Individual Provider Application ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the General Individual Application/Reactivation Checklist. Indicate whether this is a New Application or Reactivation.
3. Enter your Practitioner Name and Individual NPI #. Ensure that your Primary Service Location details, including Street, City, State, and Zip code, are accurately filled.
4. Specify who will be billing for your services by selecting either an Enrolled Billing Group or indicating if you are enrolling as an Ordering, Referring, or Prescribing provider only.
5. Complete the Provider Type and Specialty sections. Use the provided links to understand Taxonomy if needed.
6. Attach all required documents as listed in the checklist and ensure that each page is signed where necessary before submitting.

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