Facility/Agency/Organization/Institution
Use this link to begin an application on behalf of Providers who provide combined service across multiple areas:
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From the Provider tab, select the New Enrollment hyperlink.
The System displays the New Enrollment page.
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Select the Facility/Agency/Organization/Institution radio button.
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Select the Submit button.
The System displays the Basic Information page.
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Select a Provider Type.
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Select a Program.
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Enter the required (*) information based on your previous selections.
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Select the Finish button.
The System displays the Basic Information page.
Important Note: The System displays a message providing the Application #. Make note of this number as it, along with the SSN or FEIN, is required to track the enrollment application.
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Select the OK button.
The System displays the Enroll Provider -Facility/Agency/Organization/Institution page.