NPI Application Changes Table

Revisions to Form CMS-10114 NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM
Issue
#
1.

2.

Page
#
All

1

Section

Action to be
performed

Changes to the Application

Reason for the Change

Each Page

Add the draft
watermark and remove
the form number/date
from each page

Add the draft watermark and removing the form number/date from
each page

Revising the application;
therefore, this date will
change.

Section 1A
Revise as follows:
under Change
of
Information:

Replace: remove
With:
‘Remove’

Revised for clarification
purposes. ‘Major’ is not
applicable.

Only complete the appropriate sections with the information that is changing. If
removing information, please indicate within the appropriate field(s) by writing
‘Remove’.

3.

1

Section 2B3

Revise as follows:

Replace: (if applicable)
With:
(if applicable see instructions)

Revised for clarification
purposes.

4.

1

Section 2B4

Revise as follows:

Add: Subpart (See Instructions)

Revised for clarification
purposes. Subparts that do
not have their own EINs
should use the Other Name
Section to report the
subpart’s name.

5.

3

Section 5A7

Revise as follows:

6.

3

Bottom of
page

Revise as follows:

Remove the asterisk from the Title/Position
Replace: Title/Position*
With: Title/Position
Replace: PRA disclosure Statement
With:
According to the Paperwork Reduction Act of 1995, no persons are
required to respond to a collection of information unless it displays a
valid OMB control number. The valid OMB control number for this
information collection is 0938-0931. The time required to complete
this information collection is estimated to average 20 minutes per
response for new applications and 10 minutes for changes per
response, including the time to review instructions, search existing
data resources, gather the data needed, and complete and review the
information collection. If you have comments concerning the
accuracy of the time estimate(s) or suggestions for improving this
form, please write to: CMS, 7500 Security Boulevard, Attn: PRA

1

Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland
21244-1850. Please do not send applications, claims, payments,
medical records or any documents containing sensitive
information to the PRA Reports Clearance Office. Please note
that any correspondence not pertaining to the information
collection burden approved under the associated OMB control
number listed on this form will not be reviewed, forwarded, or
retained. If you have questions or concerns regarding where to
submit your documents, please contact the NPI Enumerator at 1800-465-3203.

7.

6

Top of page
Revise as follows:
under Section
2B1-2

Add the following note under Section 2B1-2:
Please Note: If you are applying for an NPI for a subpart and the
subpart does not have its own EIN, please submit the LBN and EIN
for the parent organization in Sections 2B1 and 2B2 and submit the
subpart name in 2B3. If the subpart has its own LBN and EIN
(separate from the parent’s LBN and EIN), then the subpart should
submit the subpart’s LBN and EIN in Section 2B1 and 2B2. In both
cases, the subpart should check ‘Yes’ to the subpart question in
Section 1B2.

2