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NPI or Provider ID
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Enter the Provider Identification number that you want to revalidate.
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Provider ID
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Displays the provider ID that was selected from the list of providers that matched the search criteria.
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Provider Name
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Displays the selected provider's name.
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Provider Specialty
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Displays the provider specialty description associated with the provider.
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Provider Type
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Displays the provider type description associated with the provider.
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Revalidation Date
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Displays the first day the provider can begin the revalidation process. Providers have 30 days from the revalidation date to complete the process.
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Social Security Number
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Enter the Social Security Number if the tax identification number is not known.
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Tax ID
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Enter the Taxpayer identification number that is associated with the provider.
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Taxonomy
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Displays the taxonomy code that is associated with the provider.
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ZIP Code
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Enter the ZIP Code that is associated with the provider's service location.
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