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Provider Enrollment > Portable X-Ray Provider > Freestanding

Provider Enrollment


Freestanding

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:

Instructions to Complete
Enrollment Form


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