Individual Billing Provider Enrollment (Provider Identifier Numbers) Page

You use the Provider Identifier Number page to add or edit identification numbers to the individual provider's enrollment application.

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

Field	Description
National Provider Identifier (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.
Drug Enforcement Administration (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#	Provider's Drug Enforcement Administration number.
Other State Medicaid Program Information Fields
Are you currently enrolled as a Medicaid provider in another state?	Select Yes or No if the provider is currently enrolled as a Medicaid provider in another state. If Yes, select the state in which the provider is currently enrolled.
Please select all states others than NH in which you are currently enrolled as a Medicaid provider	Select all states other than NH in which you are currently enrolled as a Medicaid provider. To move an item from the Available list to the Selected list, select the item, and then click (the right arrow). To move an item from the Selected list to the Available list, select the item, and then click (the left arrow).

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 #	Provider's Medicare number.
Parts	The Medicare payments you are currently authorized to receive. Check the ones that are applicable. Examples: Parts B, Part C
Other Medicare Numbers Fields To add new history information, click Add History. Existing Medicare history information, if any, is displayed in a table. To edit, in the Other Medicare Numbers table, click the appropriate row. After you edit or add history information, on the History action bar, click Save.
Medicare #	Any provider's Medicare number assigned to you in the past.
Carrier/Intermediary Name	Name of the Medicare carrier or intermediary.
Parts	The Medicare payments you were authorized to receive. Check the ones that are applicable. Examples: Parts B, Part C