Provider Enrollment Handout - Palmetto GBA

What is Your Business Structure?□ One Owner□ Sole owner, not incorporated□ Submit 855I□ Sole owner, incorporated□ Must have both Type I (Individual) and Type II (Organizational) NPI and submit 855I□ Multiple Owners□ Must have Type I and Type II NPI□ Must be signed by A/O or D/O as required□ Submit 855BSolely Owned Organizationvs. Sole ProprietorSolely Owned Organization Providers who are the soleowners of theirincorporated business (Inc.,LLC, PC, etc.) Be sure to include allbusiness information insection 4A of CMS 855I In most cases, a Type 2Organizational NPI isneeded for the businessSole Proprietor Physician operates anunincorporated businessand the business name isthe same as his/her name Be sure to include theindividual taxidentification informationin section 4F of CMS 855I5