National Provider Identifier (NPI) Application-Update Form {CMS-10114}

CMS-10114 - NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM. This form is used by health care providers and organizations to apply for, update, reactivate, or deactivate their National Provider Identifier (NPI), a unique 10-digit identification number required under federal law for all covered health care providers in the United States. This form is applicable to both individual providers (such as physicians, nurses, and dentists) and organizational entities (such as hospitals, group practices, and clinics), and must be completed either for an initial application or when making changes to existing NPI information. The form collects extensive data including the provider's legal name, business addresses, taxonomy codes (specialties), license numbers, and identifying information such as Social Security Number or Individual Taxpayer Identification Number for individuals, or Employer Identification Number for organizations. The form must be completed legibly, in blue or black ink, and includes a certification section requiring a signature attesting to the accuracy of the information provided. Depending on the nature of the submission (e.g., change of name, birth date, or deactivation due to death), supporting documents such as a driver’s license or death certificate may be required. Submission of this form ensures that providers are accurately recorded in the National Plan and Provider Enumeration System (NPPES), allowing for streamlined claims processing, communication with insurers, and compliance with HIPAA regulations. Failure to provide accurate information can delay processing, result in denial, or lead to legal penalties. www.FormsWorkflow.com