Provider Enrollment > Portable X-Ray Provider > Freestanding

Provider Enrollment


Enrollment information for Portable X-Ray Freestanding Providers

Freestanding Providers ...

Services provided to QMB's only (Qualified Medicare Beneficiaries). This service is NOT available to all Medicaid beneficiaries or individuals with Medicare Part B.

NOTE: To provide services to beneficiaries with NYS Medicaid coverage only, complete Options 1 and 2.

Complete the Enrollment Form below if you are: