NPI provider registration forms
Participating provider registration form
If you would like to be a participating provider, please submit a provider participation form to start the credentialing process.
Nonparticipating provider registration forms
If you are a nonparticipating provider and need to register your NPI with Independence, 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.