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NPI Provider Registration Forms

Participating Provider Registration Forms

Participating providers can register their NPIs with AmeriHealth by selecting the appropriate NPI registration form below, completing the form, and submitting it along with a copy of the provider’s NPI confirmation per the instructions provided at the bottom of the form.

Participating Provider NPI Registration Form Type	Appropriate Registration Form
Professional Providers (e.g., PCPs, specialists)	Par Professional Registration Form
Facility/Ancillary Providers (e.g., hospitals, rehabs, DME, ambulance)	Par Facility/Ancillary Registration Form

Nonparticipating Provider Registration Forms

Nonparticipating providers can register their NPIs with AmeriHealth by selecting the appropriate NPI registration form below, completing the form, and submitting it along with copies of the provider’s NPI confirmation and a completed W-9 form per the instructions provided at the bottom of the form.

Nonparticipating Provider NPI Registration Form Type	Appropriate registration form
Professional Providers (e.g., PCPs, specialists)	Nonpar Professional registration form
Facility/Ancillary Providers (e.g., hospitals, rehabs, DME, ambulance)	Nonpar Facility/Ancillary registration form
Nonmedical/Atypical Providers (e.g., nonmedical transportation)	Nonpar Nonmedical/Atypical registration form