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Click ‘Get Form’ to open the national provider identifier NPI application update form in the editor.
Begin with Section 1, Basic Information. Indicate the reason for submitting the form by checking the appropriate box: Initial Application, Change of Information, Deactivation, or Reactivation. Fill in your NPI if applicable.
In Section 1B, select your entity type—either an individual or an organization—and complete the relevant sections based on your choice.
Proceed to Section 2 for Identifying Information. Provide your full legal name and any other names you may have used. Ensure that all information matches official records.
Complete Section 3 with your business addresses and contact details. This is crucial for communication regarding your application.
In Section 4, review and sign the Certification Statement to confirm that all provided information is accurate and complete.
Finally, fill out Section 5 with a contact person's information who can be reached for any questions about your application.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (129 Votes)
2018	4.3 Satisfied (205 Votes)
2012	4 Satisfied (24 Votes)
2008	4.3 Satisfied (255 Votes)
2007	4.1 Satisfied (35 Votes)
2005	4.3 Satisfied (72 Votes)

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Do you need to update your NPI?

CMS-10114 is a form used by healthcare providers and organizations to report specific information related to Medicare and Medicaid services.

How do I update my NPI form online?

You must notify the enumerator of any changes within 30 days of the change. 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.

change npi address

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