Group Provider Enrollment (Provider Identifier Numbers) Page

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You use the Provider Identifier Numbers page to add or edit identification numbers to a group provider's enrollment application.

The Provider Identifier Number page for Group Provider Enrollment contains the following panels:

Provider Identifier Numbers-Section 3 Fields

Field	Description
National Provider Identification (NPI) Fields To add a new NPI, click Add NPI. Existing NPIs, if any, are listed in a table. To edit, in the NPI table, click the appropriate row. After changing or adding an NPI number, on the NPI action bar, click Save.
NPI	Provider's National Provider Identifier number. Note: This field is required for all typical providers. An enrollment application cannot be submitted without an NPI.
Drug Enforcement Agency (DEA) Fields To add a new DEA, click Add DEA. Existing DEA numbers, if any, are displayed in a table. To edit, in the DEA table, click the appropriate row. After changing or adding a DEA number, on the DEA action bar, click Save.
DEA #	The provider's Drug Enforcement Agency number.
NCPDP Fields To add new National Council for Prescription Drug Program information, click Add NCPDP. Existing NCPDP information, if any, is displayed in table. To edit, in the NCPDP table, click the appropriate row. After changing or adding the information, on the NCPDP action bar, click Save.
NCPDP	The seven-digit National Council for Prescription Drug Program (NCPDP) provider ID for a licensed pharmacy or qualified non-pharmacy dispensing site.

Field

Description

National Provider Identification (NPI) Fields

To add a new NPI, click Add NPI. Existing NPIs, if any, are listed in a table. To edit, in the NPI table, click the appropriate row. After changing or adding an NPI number, on the NPI action bar, click Save.

NPI

Provider's National Provider Identifier number.

Note: This field is required for all typical providers. An enrollment application cannot be submitted without an NPI.

Drug Enforcement Agency (DEA) Fields

To add a new DEA, click Add DEA. Existing DEA numbers, if any, are displayed in a table. To edit, in the DEA table, click the appropriate row. After changing or adding a DEA number, on the DEA action bar, click Save.

DEA #

The provider's Drug Enforcement Agency number.

NCPDP Fields

To add new National Council for Prescription Drug Program information, click Add NCPDP. Existing NCPDP information, if any, is displayed in table. To edit, in the NCPDP table, click the appropriate row. After changing or adding the information, on the NCPDP action bar, click Save.

NCPDP

The seven-digit National Council for Prescription Drug Program (NCPDP) provider ID for a licensed pharmacy or qualified non-pharmacy dispensing site.

Medicare Crossover Payment- Section 3 Fields

Field	Description
To add new Medicare information, click Add Medicare. Existing Medicare information, if any, is displayed in a table. To edit, in the Medicare Numbers table, click the appropriate row. After you edit or add Medicare information, on the Medicare # action bar, click Save.
Medicare Numbers	The Medicare number of the provider or group.
Part	The Medicare payments you are currently authorized to receive. Examples: All, Parts A, Part B, Part C, and Part D
Medicare History Fields To add new history information, click Add History. Existing Medicare history information, if any, is displayed in a table. To edit, in the Medicare History table, click the appropriate row. After you edit or add history information, on the History action bar, click Save.
Medicare #	Any provider or group Medicare number assigned to you in the past.
Carrier/Intermediary Name	Name of the Medicare carrier or intermediary.
Part	The Medicare payments you were authorized to receive. Examples: All, Parts A, Part B, Part C, and Part D

Field

Description

To add new Medicare information, click Add Medicare. Existing Medicare information, if any, is displayed in a table. To edit, in the Medicare Numbers table, click the appropriate row. After you edit or add Medicare information, on the Medicare # action bar, click Save.

Medicare Numbers

The Medicare number of the provider or group.

Part

The Medicare payments you are currently authorized to receive.

Examples: All, Parts A, Part B, Part C, and Part D

Medicare History Fields

To add new history information, click Add History. Existing Medicare history information, if any, is displayed in a table. To edit, in the Medicare History table, click the appropriate row. After you edit or add history information, on the History action bar, click Save.

Medicare #

Any provider or group Medicare number assigned to you in the past.

Carrier/Intermediary Name

Name of the Medicare carrier or intermediary.

Part

The Medicare payments you were authorized to receive.

Examples: All, Parts A, Part B, Part C, and Part D