To expedite the enrollment process, you can begin collecting copies of documents that you will need to include when you submit the completed enrollment form:

	A copy of the facility's home-state license to cover the application date through the current date.
	A copy of the DEA certificate to cover the application date through the current date.
	A copy of your FEIN documentation showing both the name and number preprinted (a W-9 is not sufficient for enrollment purposes).
	A copy of your Medicare award or participation letter.
	A list of the facility's or program's owners and/or Board of Directors with addresses.
	A copy of your NPI assignment notification.
	A confirmation notice for the OMIG Provider Compliance Program may be required. Visit www.omig.ny.gov to determine if the provider must comply. If yes, copy of the confirmation notice (printed from the website) must be included with the enrollment application.

• Out-of-State (OOS) Hospital Enrollment Package Request Form
• Inpatient Provider Manual
• Clinic Provider Manual
• ETIN