General Information

Applicant Information

  • Applicant Name: Name of the Lead HCP
  • FCC Registration Number (FRN): FRN of the Lead HCP. See Slides 37-40 for additional information.
  • National Provider Identifier (NPI): The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique 10-digit identification number for covered HCPs.
  • Federal Employer Identification Number (EIN/Tax ID): For more information, see Slide 48.
  • DATA Act Business Type: See Slides 28-29 for additional information.
  • Service Area: Applicants must enter the name of the applicable state, District of Columbia, territory, or “nationwide”

Contact Information

  • Contact information for individual responsible for the application at the Lead HCP, as well as a project manager:
    • Name
    • Position Title
    • Company Name
    • Phone Number
    • Mailing Address
    • Email Address
    • Project Manager Name
    • Project Manager Phone Number
    • Project Manager Email Address