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Get and Sign NPI Dissemination Form for BCBSM

Get and Sign NPI Dissemination Form for BCBSM

Use a NPI Dissemination Form For BCBSM 0 template to make your document workflow more streamlined.

Form for BCBSM Medicare NPIs for Professional Providers If you have any professional NPIs that you registered with Medicare but did not register with BCBSM please send them to us by completing the chart below and include the NPI the Medicare legacy number associated with the NPI the BCBSM PIN that should be linked to the NPI and the Tax ID number. Authorized Representative Signature Contact Telephone Number Fax this completed form to the Provider Enrollment NPI Unit at 866-504-0449....
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