Npi application form 2026

The document is the National Provider Identifier (NPI) Application/Update Form issued by the Department of Health and Human Services Centers for Medicare & Medicaid Services. It outlines the process for healthcare providers to apply for or update their NPI, including sections for basic information, identifying details, addresses, certification statements, and penalties for falsifying information. The form emphasizes the importance of providing accurate information to avoid delays in processing and issues with insurers.

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Click ‘Get Form’ to open the NPI application form in the editor.
Begin with Section 1, where you will select the reason for submitting the form. Choose from options like 'Initial Application' or 'Change of Information' by checking the appropriate box.
In Section 2, provide your identifying information. If you are an individual, fill out your name details including prefix, first name, last name, and credentials. If applicable, include any other names.
Proceed to Section 3 to enter your mailing address and practice location information. Ensure all fields are filled accurately to avoid delays.
In Section 4, review and sign the certification statement confirming that all provided information is true and complete. This section requires signatures from both individual practitioners and authorized officials if applicable.
Finally, complete Section 5 by providing contact person information. Make sure to include an email address for efficient communication regarding your application.

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