¹ This is your individual or organization NPI. This is used for identity verification purposes only and is not used when accessing claims and eligibility.

² This is the Employer Identification Number or Social Security Number associated with your private practice. You may enter the Tax IDs of any clinics or hospitals you practice at under in 'Facility Tax IDs' section.

³ Enter the Tax IDs (TINs) for which you are requesting the ability to manage provider access to claims and eligibility.