National Provider Identifier (NPI) Application and Update Form

National Provider Identifier (NPI) Application and Update Form and Supporting Regs in 45 CFR 142.408, 45 CFR 162.408, 45 CFR 162.406

OMB: 0938-0931

IC ID: 179125

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
IC Document
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National Provider Identifier (NPI) Application and Update Form
 
No Modified
 
Mandatory
 
45 CFR 142.408 45 CFR 162.406 45 CFR 162.408

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction CMS-10114 NPI Application/Update Form DRAFT - Revised CMS-10114 (08082011 without watermark).pdf Yes Yes Fillable Printable

Health Health Care Services

 

142,799 0
   
Private Sector Not-for-profit institutions, Businesses or other for-profits
 
   75 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 142,799 0 0 -147,001 0 289,800
Annual IC Time Burden (Hours) 47,600 0 0 -49,000 0 96,600
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Crosswalk Revised NPI Application Changes Table 07152011.doc 11/30/2011
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.
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