National Provider Identification Number (NPI) Submission Form
Effective May 23, 2007 the Health Insurance Portability and Accountability Act (HIPAA) will require all health care providers, defined as "covered entities", to begin using a unique 10-digit identification number when submitting all HIPAA standard transactions,
This number will replace your existing Virginia Premier Provider ID, which is also the Medicaid Provider ID Number. If you have not yet applied for and received your individual and group (if applicable) NPI Number, you may do so by choosing one of the following options;
- Apply for an NPI number via the Web at https://nppes.cms.hhs.gov
- Download the application from the Website above and mail it to:
PO Box 6059
Fargo, ND 58108-6059
If you have obtained your individual and/or NPI group number and are ready to provide it to Virginia Premier, please complete the form below. An asterisk (*) denotes a required field for a completed section. We are working very diligently to ensure that your claim payments and demographic information is accurate in our systems. Please provide as much information as possible. If you have multiple NPI Numbers, please complete a separate form for each NPI Number.
Fields with a * beside them are mandatory (Please note that all information provided is confidential).