Provider Index > Physician > Order/Prescribe/Refer/Attend
Provider Enrollment & Maintenance
Special Note for Attending Physicians:
Attending Physicians 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.
Complete this Enrollment Form if you are: - Applying for initial ENROLLMENT or ALREADY ENROLLED and enrolling another NPI, or
- Responding to a letter instructing you to REVALIDATE your enrollment, or
- Seeking REINSTATEMENT or REACTIVATION of your previous enrollment
Orderer-Prescribers-Referrers-Attending Enrollment Form