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........................................................................................................................................... 1  \n2 Contents .......................................................................................................................................... 1  \n2.1 General Information ........................................................................................................ 1  \n2.2 Enrollment Qualifications ................................................................................................ 1  \n2.3 Accuracy of Information .................................................................................................. 2  \n2.4 Notice Regarding Use of Social Security Number .......................................................... 2  \n2.5 Supporting Documentation Requirements ...................................................................... 2  \n2.6 Enrollment Process ......................................................................................................... 2  \n3 Before You Enroll ........................................................................................................................... 2  \n4 Submitting a Provider Enrollment Application............................................................................ 3  \n4.1 Navigation ....................................................................................................................... 3  \n4.2 Welcome Statement ........................................................................................................ 3  \n4.3 Enrollment Type .............................................................................................................. 3  \n4.4 Enrollment Type Confirmation ......................................................................................... 4  \n4.5 Application Tips ............................................................................................................... 4  \n4.6 Request Type .................................................................................................................. 5  \n4.7 Before You Continue ....................................................................................................... 6  \n4.8 Identifying Information ..................................................................................................... 6  \n4.9 Certification and Attestation Panel .................................................................................. 7  \n4.10 License & More Identifying Information ........................................................................... 7  \n4.11 Collaboration Agreement ................................................................................................ 8  \n4.12 Contact Information ......................................................................................................... 8  \n4.13 Service Location .............................................................................................................. 8  \n4.14 Mailing Address ............................................................................................................... 9  \n4.15 Pay To Address ............................................................................................................... 9  \n4.16 Home/Corp Office Address ............................................................................................. 9  \n4.17 Xref NPI ......................................................................................................................... 10  \n4.18 ATN Information ............................................................................................................ 10  \n4.19 Member of the Following Groups .................................................................................. 11  \n4.20 Billing Agent Agreement.","cbCaiirE6e2ZekZp","https://ap.wps.com/l/cbCaiirE6e2ZekZp","pdf",1673969,24,"English","# Purpose\n# Contents\n## General Information\n## Enrollment Qualifications\n## Accuracy of Information\n## Supporting Documentation Requirements\n## Enrollment Process\n# Before You Enroll\n# Submitting a Provider Enrollment Application\n## Navigation\n## Enrollment Type\n## Enrollment Type Confirmation\n## Application Tips\n## Request Type\n## Identifying Information\n## Certification and Attestation Panel\n## License & More Identifying Information\n## Collaboration Agreement\n## Contact Information\n## Service Location\n## Mailing Address\n## Pay To Address\n## Home/Corp Office Address\n## Supporting Documents\n## Certification\n## Application Confirmation\n## Verifying the Status of an Enrollment Application\n## Application Status Descriptions\n## Submitting Corrections to a 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