Providers
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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.