The CMS-10114 NPI application form is the paper application health care providers use to obtain a National Provider Identifier, the ten-digit number required for HIPAA-standard electronic transactions. There is no fee. You mail the completed form to the NPI Enumerator in Windsor Mill, Maryland, and paper processing runs about 20 business days.1Centers for Medicare & Medicaid Services. How to Apply The form has four sections, and most rejections come from problems that are easy to prevent if you gather the right information before you start writing.
Before You Start
Download the PDF from the CMS website, or call the NPI Enumerator at 1-800-465-3203 (TTY 1-800-692-2326) or email customerservice@npienumerator.com to request a paper copy.2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114 Print or type in blue or black ink. Pencil is not accepted.
Have these ready before you begin:
- Your Social Security Number, or your ITIN if you don’t qualify for an SSN
- For organizations, the Employer Identification Number from the IRS
- State license, registration, or certificate numbers and the issuing states
- Your 10-character taxonomy code from the National Uniform Claim Committee lookup at taxonomy.nucc.org3Centers for Medicare & Medicaid Services. Health Care Taxonomy
- Two proofs of identity if you plan to leave the SSN field blank (passport, birth certificate, driver’s license photocopy, or state ID; visas and employer IDs are not accepted)
Which sections you complete depends on whether you are an individual (a Type 1 NPI, for a single physician, nurse practitioner, dentist, or sole proprietor) or an organization (a Type 2 NPI, for a group practice, hospital, pharmacy, or similar entity).4Centers for Medicare & Medicaid Services. NPI Fact Sheet An individual who has incorporated may need both, filed as two separate applications.
Section 1: Reason for Submission
Check the box that matches your purpose:2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114
- Box 1: Initial application for a new NPI
- Box 2: Change of information on an existing NPI
- Box 3: Deactivation of an existing NPI
- Box 4: Reactivation of a previously deactivated NPI
For a new application, also indicate whether you are applying as an individual or an organization, and whether the entity is a subpart of a larger organization.
Section 2A: Individual Provider Information
Enter your full legal name with no initials or abbreviations, along with your date of birth, country of birth, and sex.2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114 If you provide your SSN, the name and date of birth on the form must match Social Security Administration records exactly. A mismatch is one of the most common reasons paper applications get returned.
Block 18, the SSN field, is technically optional. Leaving it blank is allowed, but you must then include two of the accepted identity documents with the application, or processing will stall.
Block 19 is for an ITIN, and it applies only to applicants who do not qualify for an SSN. You cannot enter an ITIN if you have an SSN, and an EIN does not go in this field. An ITIN submission must include a photocopy of a driver’s license, state ID, birth certificate, or passport.
Section 2B: Organization Provider Information
Enter the legal business name exactly as it appears on IRS tax filings, along with the EIN. Both are required.2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114
If you are applying for a subpart that has no EIN of its own, put the parent organization’s legal name and EIN in fields 1 and 2, then enter the subpart’s name in field 3. If the subpart has its own EIN, use the subpart’s information in fields 1 and 2. Either way, check “Yes” for the subpart question in Section 1B2.
Section 3: Addresses, Taxonomy Code, and License Numbers
Section 3 applies to both individuals and organizations and has several parts.
The correspondence mailing address is where the Enumerator will send your NPI notification. A P.O. Box is acceptable here. The primary practice location must be a physical street address where you see patients or provide services, not a P.O. Box.
The “other provider identification numbers” field is optional. You can list identifiers assigned to you by health plans so they can match your new NPI to your existing records. Do not enter your SSN, ITIN, or EIN here.
Enter your 10-character taxonomy code identifying your provider type and specialization. At least one primary code is required. If you practice in more than one specialty, you can list additional codes, but one must be designated primary because billing systems default to it. Then enter your state license, registration, or certificate numbers with the issuing state.
Taxonomy codes and license numbers cause more returned applications than any other field on the form. A wrong taxonomy code means your NPI will not match your specialty for billing. A wrong license number will fail verification. Check both against your current state board records before you mail the form.2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114 CMS also publishes a Medicare provider and supplier crosswalk on data.cms.gov that maps provider types to taxonomy codes if you are unsure which to pick.
Section 4: Certification and Signature
Individual applicants sign in Section 4A. Organizations have an authorized official sign in Section 4B. Signing certifies that all information is true and commits you to notifying the NPI Enumerator of any changes within 30 days.5eCFR. 45 CFR 162.410 – Health Care Providers Knowingly submitting false information on a federal form can bring fines or up to five years in prison under 18 U.S.C. ยง 1001.6Office of the Law Revision Counsel. 18 U.S. Code 1001 – Statements or Entries Generally
Someone other than the provider may complete and submit the form on the provider’s behalf, but the certification statement binds whoever signs.7NPPES. Apply for an NPI
Where to Mail the Form
Send the signed application to:
NPI Enumerator
7125 Ambassador Road, Suite 100
Windsor Mill, MD 21244-27511Centers for Medicare & Medicaid Services. How to Apply
The form’s own instructions warn that failing to include pages 3, 4, and 5 with complete and accurate information may cause the application to be returned. Before you seal the envelope, check that every required field is filled in legibly, that all pages are enclosed, and that any supporting documents (identity proofs for a blank SSN field, a death certificate for a deactivation) are included. Keep a photocopy of everything you send.
After You Submit
Staff at the NPI Enumerator manually key the application into NPPES and verify credentials against national databases. Paper processing runs about 20 business days, roughly twice as long as an online application through NPPES, which can finish in as little as 10 days. If the Enumerator finds errors or missing information, they contact the person listed in the contact section of the form for clarification before issuing the NPI.
Once approved, your NPI arrives by mail at the correspondence address in Section 3. You can also verify it later through the NPPES online registry or by calling 1-800-465-3203.
Changes, Deactivations, and Reactivations
You use the same CMS-10114 for updates, deactivations, and reactivations by checking box 2, 3, or 4 in Section 1, entering the affected NPI, completing Section 2, and signing Section 4.2Centers for Medicare & Medicaid Services. NPI Application Form CMS-10114 Changes must be reported within 30 days of the event, including changes to your name, practice address, phone number, taxonomy code, or license status. If a deactivation follows a provider’s death, the Power of Attorney or executor signs Section 4 and encloses a copy of the death certificate or obituary. An NPI is never reassigned, so a reactivation restores the same number the provider originally received. All three actions can also be handled through the NPPES online portal, which gives faster confirmation than paper.