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NPI Registration Form - Easter Seals

NPI Registration Form - Easter Seals 2025

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The document outlines the requirements for healthcare providers to obtain a National Provider Identifier (NPI) for identification in HIPAA transactions, specifically for Florida Medicaid. It explains how to create unique crosswalks between NPI and Medicaid provider IDs, emphasizes the importance of using consistent combinations of NPI, taxonomy, and ZIP code for billing, and provides resources and instructions for registration.

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Click ‘Get Form’ to open the NPI Registration Form in our editor.
Begin by filling in your Provider’s Name clearly in the designated field. Ensure that it is legible for processing.
Next, enter your Provider Medicaid Number. This is essential for linking your NPI with Florida Medicaid.
In the NPI field, indicate your National Provider Identifier. If you are not eligible for an NPI, please write 'atypical'.
If applicable, provide your Taxonomy code. This helps in categorizing your healthcare services accurately.
Fill in the ZIP + 4 code if relevant. This ensures precise identification of your location.
Sign the form as the provider or authorized agent if submitting on behalf of a group. Include the date and print the signer’s name and title.
Once completed, submit the form via regular mail or overnight delivery to the specified addresses provided at the bottom of the form.

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Versions	Form popularity	Fillable & printable
2008	4.9 Satisfied (54 Votes)
2007	4 Satisfied (49 Votes)

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What is the NPI entry form?

The NPI is a numeric identifier that is assigned to a health care provider by the Centers. for Medicare Medicaid Services (CMS). It is a 10-digit permanent number assigned to a provider and must be used on electronic claim transactions for health care billing and reimbursement.

Who is responsible for NPI?

The National Provider Identifier (NPI) is the numeric identifier that is assigned to physicians and other health care providers by the Centers for Medicare Medicaid Services (CMS). It is the 10-digit permanent number assigned to you for your entire medical career.