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NPI Provider Registration Forms
Participating Provider Registration Forms
If you are a participating provider and need to register your NPI with Independence Blue Cross (IBC), select the appropriate NPI registration form below. Complete the form and submit it along with a copy of your NPI confirmation and a completed W-9 form.
| Participating Provider NPI Registration Form Type | Link to 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
If you are a nonparticipating provider and need to register your NPI with IBC, select the appropriate NPI registration form below. Complete the form and submit it along with a copy of your NPI confirmation and a completed W-9 form.
| Nonparticipating Provider NPI Registration Form Type | Link to 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 |
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