NPI Dissemination Form for BCBSM: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out NPI Dissemination Form for BCBSM with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the NPI Dissemination Form in our platform's editor.
Begin by filling out the NPI Number field. This is crucial as it identifies your Medicare NPIs registered with Medicare.
Next, enter the Medicare Legacy Number associated with each NPI. This number helps link your NPI to your Medicare records.
In the BCBSM Provider PIN section, input the PIN that should be linked to your NPI. This ensures proper processing of claims.
Fill in the Tax ID number related to your practice. This is necessary for accurate identification and billing purposes.
Finally, sign as an Authorized Representative and provide a contact telephone number for any follow-up inquiries.
Once completed, save your form and utilize our platform’s features to fax it directly to the Provider Enrollment NPI Unit at 866-504-0449.

Start using our platform today for free to streamline your document editing and submission process!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

How do I update my NPI information?

The Type 1 NPI represents an individual provider and is required on all claims to indicate the individual who rendered the service. The Type 2 NPI represents a health care business or organization and can be used for billing purposes.

How long does it take for NPI info to update?

Announcing the Revised CMS-10114 National Provider Identifier (NPI) Application/Update Form Phone: 1-800-465-3203 or TTY 1-800-692-2326. E-mail: customerservice@npienumerator.com. Mail: NPI Enumerator. 7125 Ambassador Road Suite 100. Windsor Mill, MD 21244-2751.

How do you update your NPI number information?

Most changes will not change your NPI number. Only rare circumstances such as fraudulent use of your NPI number will require that you be issued a new number. You can change the information in your NPI file online. You may either create a user ID or, if you have one already, log in and update your information.

How to get an NPI letter?

Organizations can apply online or by mail through the CMS NPI Application/Update Form page. DHCS encourages organizations to use the NPI online application process as it is the fastest way to obtain an NPI and the easiest way to track the application process.

How will the NPI number be used on a claim form?

Free NPI Number Lookup Search The NPI Enumerator can be docHubed at (800) 465-3203 or P.O. Box 6059, Fargo, ND 58108. We do not guarantee the accuracy and/or reliability of the contents found on this website. Anyone may request NPI and other healthcare provider data from the HHS under the FOIA.