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The Organizational Provider Profile page captures the organization profile information associated with a Type 2 NPI.

Employer Identification Number (EIN)Boutique Turk Boutique Top Swimsuit Trina Swimsuit Trina Turk Boutique Boutique Top Trina Top Turk Swimsuit wAUqaxxv

The Health Insurance Portability & Accountability Act of 1996 (HIPAA) requires that employers have standard national numbers that identify them on standard transactions. The Employer Identification Number (EIN) is issued by the Internal Revenue Service (IRS).to identify a business entity. SSNs should never be reported in the EIN field.

Is the Organization a subpart? :

You are required to identify whether or not the organization is a subpart. If the organization is subpart of another organization then select the radio button ‘Yes’. If the organization is not a subpart of another organization then select a radio button that indicates as ‘No’.

Is the parent EIN the same as the subpart EIN?

Sweater Sweater Russell Sweater BKE Russell Russell BKE BKE Russell Russell Sweater BKE BKE BKE Sweater Russell If you selected ‘Yes’ indicating the Provider Organization is a subpart, the system will ask you if the Provider Organization’s EIN is the same as the Parent Organization’s EIN. Select ‘Yes’ if the EINs are the same, or select ‘No’ if the EINs are different.

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Parent Organization EIN:Calvin Calvin Boutique Boutique Klein Calvin Klein Shorts Boutique Shorts wxqUIEYH

If you selected ‘No’ indicating the Parent EIN is different from the Provider Organization, you will be required to enter the Parent EIN.

Parent Organization LBN:

If you selected ‘No’ indicating the Parent EIN is different from the Provider Organization, you will be required to enter the Parent Organization’s Legal Business Name (LBN). If the Parent EIN is already in NPPES, you will have the ability to select the appropriate LBN from a dropdown list. If the Parent EIN is not in NPPES, you will be required to enter the Parent Organization’s LBN.

Other Name:

If your organization uses, or previously used another name, supply those other names here. This information is not required. You have the ability to enter one or more Other Names.

Type of Other Name:

Sweater Sweater Sweater Russell BKE Russell Russell Russell Sweater BKE BKE Sweater BKE Russell BKE BKE Russell Select the ‘Type of Other Name’ dropdown list. You can select from the following three options. * Doing Business As * Former Legal Business Name * Other Name

Organizational Other Names Grid and Navigation Buttons

The following are the navigation buttons associated with the Other Name section: Clear Button: Upon selecting the ‘Clear’ button the information populated in the Other Name fields will be cleared. Save Button: Upon selecting the ‘Save’ button information populated in the Other Name fields will be saved to the Grid.

Authorized Official For the Organization:

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Provide the full legal name of the Authorized Official for the Organization. An Authorized Official is an appointed official with the legal authority to make changes and/or updates to the provider’s status (e.g., change of address, etc.) and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier. The authorized official must be a general partner, chairman of the board, chief financial officer, chief executive officer, direct owner of 5 percent or more of the provider being enumerated, or must hold a position of similar status and authority within the provider organization.

Authorized Officials Name and other details:Boutique Isaac Swimsuit for Target Top Mizrahi U0U6Y

Prefix:
Select the appropriate name prefix from the dropdown list.
  • Dr.
  • Russell Russell BKE Sweater BKE BKE Russell Russell Sweater Sweater Russell BKE Russell BKE BKE Sweater Sweater Miss
  • Russell BKE BKE Sweater Russell BKE Sweater Sweater Sweater BKE Russell BKE Sweater Russell Russell Russell BKE Mr.
  • Mrs.
  • Ms.
  • Prof.
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First Name:
Provide the First name of the Authorized Official. This is a mandatory field.
Middle Name:
Russell Sweater BKE BKE Russell BKE BKE Sweater Russell Russell Sweater Sweater BKE Sweater Russell Russell BKE Provide the Middle Name of the Authorized Official. This field is optional.
Last Name:
Provide the Last Name of the Authorized Official. This is a mandatory field.
Suffix:
Select the Authorized Official’s name suffix from the dropdown list, if applicable.
  • I
  • II
  • III
  • IV
  • V
  • VI
  • VII
  • Sweater Sweater Russell BKE Russell Russell Sweater Sweater BKE BKE BKE BKE Russell Russell BKE Sweater Russell VIII
  • IX
  • X
  • Jr.
  • Sr.
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Credential(s): (M.D, D.O, etc.) Providing the Authorized Official’s credentials is optional. Title/Position:

Provide the Title and or Position of the Authorized Official of the Organization. This is a mandatory field.
Telephone Number:
Provide the Telephone Number. This is a mandatory field.
Extension:Wool Crew Sweater Boutique Pullover J gZvwC
Sweater BKE BKE Russell BKE Russell Sweater Sweater Russell BKE Sweater Sweater BKE BKE Russell Russell Russell Provide Telephone Number Extension, if applicable.

Organizational Provider Page: -~~~~~~~~~~~~~~~~~~~~~~ Next Button:

Upon selecting the ‘Next’ button you will be navigated to the Address Page.
Save & Return to Main Page Button:Cardigan Cache Boutique Boutique Cache Cardigan W4Hfvv
Russell BKE Sweater Sweater Sweater Sweater Russell BKE Russell Sweater Russell BKE Russell BKE Russell BKE BKE Russell Russell Russell Sweater Sweater Russell BKE BKE Russell Sweater BKE BKE Russell Sweater BKE Sweater BKE Upon selecting the ‘Save and Return to Main Page’ button, you will be navigated to the Main.

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