Provider Index > Portable X-Ray > Hospital
Provider Enrollment & Maintenance
Portable X-Ray Demonstration Providers:
To participate in the Portable X-Ray Demonstration Project which allows you to provide services to beneficiaries with NYS Medicaid coverage only.
NOTE: To provide services to beneficiaries with NYS Medicaid coverage only, complete Options 1 and 2.
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, or
- Reporting an OWNERSHIP CHANGE, or
- Reporting a RECEIVERSHIP
INSTITUTION Enrollment Form