Npi application fillable form 2025

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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 health care providers to apply for or update their NPI, which is a unique identifier used in standard transactions for health care services. The form requires detailed information about the applicant, including personal identification, business addresses, and certification of accuracy. It also includes penalties for falsifying information and instructions for completing the form.

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Click ‘Get Form’ to open the NPI application fillable 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' and provide your NPI if applicable.
In Section 2, enter your identifying information. For individuals, include your full legal name, date of birth, and Social Security Number (if applicable). Organizations should provide their legal business name and Employer Identification Number (EIN).
Proceed to Section 3 to fill in your business addresses. Ensure that you provide a valid business mailing address and primary practice location. This is crucial for communication regarding your application.
Complete Section 4 by signing the certification statement, confirming that all provided information is accurate. If you're representing an organization, ensure an authorized official signs this section.
Finally, in Section 5, provide contact information for someone who can answer questions about the application process.

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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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What is a CMS 10114 form?

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

How long does it take to get an NPI number approved?

This online application takes fewer than 30 minutes once you have assembled the required documents such as your social security number and state license information. If you apply by mail, factor in turnaround time for processing and mailing. You must have an NPI in order to enroll in Medicare.

Does it cost money to get an NPI number?

There is no charge to get an NPI.

Is the NPI application free?

Applying for an NPI is free, easy, and typically takes 20 to 30 minutes to complete. Organizations can apply online or by mail through the CMS NPI Application/Update Form page.

How do I get a free NPI number?

How to Apply 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.

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