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P.O
PA
Page Navigation Options
   1.5 Add Group Members
   1.3 NPI
   3.4.2 Q15
   3.3.4 Q16
   3.3.5 Q17
   3.4.1 Q14
   3.3.1 Q11
   3.3.2 Q12
   3.3.3 Q13
   3.2.1 Q4
   3.1.1 Q1
   1.9 Language Information
   1.8 Contact Information
   1.7 Address Information
   1.6 Additional Identifiers
   1.4 Taxonomy
   3.2.3 Q6
Partner Portal
   1.5 Add Group Members
   1.0 Start New Enrollment
   1.4 Taxonomy
Partner Portal application
Partner Portal Database
Pay
   1.8 Contact Information
   1.7 Address Information
Pay-To/1099 and Mailing
Pending application
Permanent Resident Card
Pharmacy
Physician Assistant
Please
   3.3.4 Q16
   3.4.1 Q14
   3.3.1 Q11
   3.3.2 Q12
   3.3.3 Q13
   1.1a Basic Information
Please provide
Populate
   3.3.4 Q16
   3.3.1 Q11
   3.3.2 Q12
   3.3.3 Q13
   3.1.1 Q1
   1.7 Address Information
   1.6 Additional Identifiers
   1.4 Taxonomy
   1.3 NPI
   3.2.3 Q6
   1.2a Tax Information
   1.1a Basic Information
Post Office Box
Practicing Telemedicine
Preferred Contact Method
Prefilled
Prepopulated
   1.1a Basic Information
   1.3 NPI
Prepopulated NPI
Previous Owner's Medicaid ID
Previous Owner's Medicaid ID Provider Type
Primary
   1.0 Start New Enrollment
   1.3 NPI
   1.7 Address Information
   1.4 Taxonomy
Primary NPI
   1.0 Start New Enrollment
   1.3 NPI
    Enter
Primary Physical
Primary Taxonomy
Professional License
Provider
   1.2b Tax Information
   Start New Enrollment
   3.4.2 Q15
   3.4.1 Q14
   3.3.1 Q11
   3.3.2 Q12
   3.2.1 Q4
   3.1.1 Q1
   1.9 Language Information
   1.8 Contact Information
   1.6 Additional Identifiers
   1.4 Taxonomy
   1.3 NPI
   1.2a Tax Information
   1.1a Basic Information
    If
    Taxonomies listed
Provider Business Name
   3.4.1 Q14
   3.3.1 Q11
   3.3.2 Q12
Provider Enumeration System
Provider Linkage Date
Provider Medicaid ID
Provider Name
Provider owns
Provider Type
   1.0 Start New Enrollment
   3.1.1 Q1
   1.6 Additional Identifiers
   1.4 Taxonomy
   1.1a Basic Information
Provider Type 85
   1.0 Start New Enrollment
   1.1a Basic Information
Provider working as
Provider's supporting
Providers
   1.5 Add Group Members
   1.0 Start New Enrollment
    Check
    correct
Providers enrolling
Public Service Corporation

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