Home
Forms Library
Additional provider number application form

Get the up-to-date application for an additional location medicare provider number form 2025 now

additional provider number application form Preview on Page 1

Show details

4.7 out of 5

37 votes

The document is an application form for existing Medicare providers seeking to obtain a provider number for a new location, re-open a closed location, or close an existing provider number. It outlines the necessary steps, eligibility requirements, and supporting documentation needed for the application process. Additionally, it provides information on residency status, relevant sections of the Health Insurance Act 1973, and guidelines for billing and claiming Medicare benefits.

Here's how it works

01. Edit your additional provider number application 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 application for an additional location medicare provider number form via email, link, or fax. You can also download it, export it or print it out.

How to rapidly redact Application for an additional location medicare provider number form online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Dochub is the best editor for updating your forms online. Adhere to this simple guide to edit Application for an additional location medicare provider number form in PDF format online for free:

Register and log in. Register for a free account, set a strong password, and proceed with email verification to start managing your templates.
Upload a document. Click on New Document and choose the file importing option: upload Application for an additional location medicare provider number form from your device, the cloud, or a protected URL.
Make changes to the sample. Use the top and left panel tools to change Application for an additional location medicare provider number form. Insert and customize text, images, and fillable fields, whiteout unnecessary details, highlight the significant ones, and provide comments on your updates.
Get your paperwork done. Send the form to other individuals via email, generate a link for faster document sharing, export the sample to the cloud, or save it on your device in the current version or with Audit Trail added.

Discover all the advantages of our editor right now!

See more application for an additional location medicare provider number form versions

We've got more versions of the application for an additional location medicare provider number form form. Select the right application for an additional location medicare provider number form version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2015	4.7 Satisfied (37 Votes)

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.

How do I apply for a Medicare number?

Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at .socialsecurity.gov.

How to obtain a Medicaid provider number?

0:20 2:56 Application specific to your provider. Type this application is usually available on the statesMoreApplication specific to your provider. Type this application is usually available on the states Medicaid. Website such as the New York State Department of Health. Website.

How to get an additional provider number?

Applying for an additional provider number Log on to HPOS using your PRODA account and elect My details, then My provider numbers. Select Create a new provider location and read the privacy note. Select Next to provide address details. Select Next to provide contact details.

How to apply for a PTAN number?

A request for a PTAN must be received on company letterhead and include all of the required elements listed below. Inquiries received without the required elements or letterhead will be returned. A request for a group practice PTAN must be submitted and signed by the authorized or delegated official (AO/DO).

How to apply for a Medicare number for providers?

To enroll in the Medicare Program, get an NPI through: Online Application: Get an Identity Access Management (IA) System user account. Then apply for an NPI in NPPES. Paper Application: Complete, sign, and mail the NPI Application/Update Form (CMS-10114) paper application to the address on the NPI Enumerator form.

application for medicare provider number allied health

Application for an additional location medicare provider number form pdf Application for an additional location medicare provider number form online Medicare provider number application form cms-855 form pdf Medicare provider number application allied health CMS-855 forms Medicare provider number application Psychologist cms-855 form download

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

What is a Medicare 855 form?

Institutional providers can apply for enrollment in the Medicare program or make a change in their enrollment information using either: The internet-based Provider Enrollment, Chain and Ownership System (PECOS), or The paper CMS-855A enrollment application.

Is the Medicare provider number the same as NPI?

Yes, you must have an NPI to do business with any health insurance company including Medicare. But, your NPI is NOT your Medicare provider number. You may obtain an NPI through NPPES by applying online, click here to go to their website. Its a quick and simple process.

Get the up-to-date application for an additional location medicare provider number form 2025 now

Here's how it works

How to rapidly redact Application for an additional location medicare provider number form online

See more application for an additional location medicare provider number form versions

Complete this form in 5 minutes or less

Got questions?

How do I apply for a Medicare number?

How to obtain a Medicaid provider number?

How to get an additional provider number?

How to apply for a PTAN number?

How to apply for a Medicare number for providers?

Complete this form in 5 minutes or less

People also ask

What is a Medicare 855 form?

Is the Medicare provider number the same as NPI?

medicare provider number application

Try more PDF tools