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Provider Enrollment > Nurse Practitioner

Provider Enrollment



Option 1
Nurse Practitioner - Individual Billing Medicaid

If you Do/Will Provide Medical Services and Bill Medicaid Click here for the Enrollment Form and Instructions.


Please Note: If you only will Order/Prescribe/Refer/Attend see Option 2 Below
Option 2
Nurse Practitioner - Order/Prescribe/Refer/Attend ONLY

Special Note for Attending Nurse Practitioners:

Attending Nurse Practitioners should complete the form below if their name/NPI will ONLY be found on a claim submitted by the Hospital. If the practitioner will be attesting for MEIPASS/EHR Incentive, do not apply as an OPRA provider.

If you ONLY will Order/Prescribe/Refer/Attend and you will NOT be Billing Medicaid, Click here for the Enrollment Form and Instructions.


Option 3

Nurse Practitioner - Change From OPRA To Billing Provider

If you are already enrolled as an Order/Prescribe/Refer/Attend (OPRA) Provider and wish to provide Medicaid Services and Bill Medicaid, Click here for the Enrollment Form and Instructions.


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