For Providers Provider Update * Indicates required fieldsConfirm your Practice InformationPractice Name/Group* Group NPI#* SpecialtiesLocation(s) InformationClick the plus sign below to add another location.Location(s) Street Address Address Line 2 City County State ZIP Phone Fax Office hours Actions Edit Delete There are no Addresses. Add Address Maximum number of addresses reached. Practitioner InformationClick the plus sign below to add another location.Physician(s) Physician Name Individual NPI# Effective Date Language Spoken Print in Directory Accepting New Patients Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Billing informationStreet Address Address Line 2 City County StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Billing PhoneBilling FaxSummary of Information Updates*Effective Date of Change MM slash DD slash YYYY Contact InformationYour Name* First Last Office Contact Phone*Email Address* Enter Email Confirm Email CAPTCHA