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