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pdf Non-visible Questions
Label
PDF Name
(step)
Location
Response
Input
Item
Visibility
Trigger
Other
Register for a new Entity
NPDB account for Registration
my organization
Below “Register
my
organization”
Radio
Button
The field is
displayed if the
user selects the
option
“Register my
organization.”
Selecting the radio
button “Register
my organization”
displays three
options: “Register
for a new NPDB
account for my
organization,”
“Renew or update
my organization’s
NPDB registration,”
and “Request
another DBID for
my organization’s
NPDB account.”
Renew or update Entity
my organization’s Registration
NPDB registration
Below “Register
my
organization”
Radio
Button
The field is
displayed if the
user selects the
option
“Register my
organization.”
Selecting the radio
button “Register
my organization”
displays three
options: “Register
for a new NPDB
account for my
organization,”
“Renew or update
my organization’s
NPDB registration,”
and “Request
another DBID for
my organization’s
NPDB account.”
Label
PDF Name
(step)
Location
Response
Input
Item
Radio
Button
Visibility
Trigger
Other
The field is
displayed if the
user selects the
option
“Register my
organization.”
Selecting the radio
button “Register
my organization”
displays three
options: “Register
for a new NPDB
account for my
organization,”
“Renew or update
my organization’s
NPDB registration,”
and “Request
another DBID for
my organization’s
NPDB account.”
Request another
DBID for my
organization’s
NPDB account
Entity
Below “Register
Registration – my
(What do you organization”
need to do?)
DBID Number
Entity
Registration –
(Select the
best option
for your
organization)
Below “Do you Text Entry
know the
current DBID for
your
organization?”
The field is
displayed if the
user selects the
“Yes” option.
Name of your
federal agency
Entity
Registration –
(Select the
best option
for your
organization)
Below “Federal
government
agency or
entity” radio
button
The field is
displayed if the
user the option
“Federal
government
agency or
entity” for
“Who owns
your
organization?”
Drop List
Label
PDF Name
(step)
Location
Response
Input
Item
Visibility
Trigger
Other
Is your
organization also
a health plan?
Entity
Registration –
(Select the
best option
for your
organization)
Below “Best
category for
your
organization”
Radio
buttons
The fields are
displayed if the
user selects a
category that
has a secondary
category for
registration.
Radio buttons
are “Yes” and
“No.”
The label for the
secondary category
is dynamic and is
dependent on the
user’s selection for
the primary
category (i.e., the
“Best category for
your organization.”
Select up to 4
additional
functions or
services
Entity
Registration –
(Select the
best option
for your
organization.)
Below drop list
“Select your
organization’s
primary health
care-related
function or
service
Check
Boxes
The fields are
displayed if
user selects the
link “Add a
function”
Selecting the link
displays all relevant
functions that
apply to the
registration
category and
secondary category
selected by the
user.
Description
Entity
Registration –
(Select the
best option
for your
organization).
Below checkbox Text Entry
for relevant
checkbox
selection
NPI (National
Provider
Identifier)
Entity
Below
Registration – Identification
(Organization Numbers
Information)
The field is
displayed if the
user selects a
function that
requires a
description.
Text Entry The field is
displayed if the
user selects a
registration
category or
secondary
category that
has an NPI.
Label
CCN (CMS
Certification
Number)
PDF Name
(step)
Location
Response
Input
Item
Visibility
Trigger
Entity
Below
Registration – Identification
(Organization Numbers
Information)
Text Entry The field is
displayed if the
user selects a
registration
category or
secondary
category that
has a CCN
ORI (Originating
Entity
Below
Agency Identifier) Registration – Identification
(Organization Numbers
Information)
Text Entry The field is
displayed if the
user selects a
registration
category or
secondary
category that
has an ORI.
Name of person
or office
Entity
Registration –
(Your Point of
Contact on
NPDB
Reports)
Text Entry The field is
displayed if the
user selects the
radio button
for “I will assign
a specific
person or office
to contact.”
Title or
department
Entity
Below “Name of Text Entry
Registration – person or office”
(Your Point of
Contact on
NPDB
Reports)
Below the radio
button “I will
assign a specific
person or office
to contact”
The field is
displayed if the
user selects the
radio button
for “I will assign
a specific
person or office
to contact.”
Other
Selecting the
checkbox displays
Name of person or
office, Title or
department,
Phone, and
Extension text
entry fields.
Selecting the
checkbox displays
Name of person or
office, Title or
department,
Phone, and
Extension text
entry fields.
Label
PDF Name
(step)
Location
Response
Input
Item
Visibility
Trigger
Other
Phone
Entity
Below “Title or
Registration – department”
(Your Point of
Contact on
NPDB
Reports)
Text Entry The field is
displayed if the
user selects the
radio button
for “I will assign
a specific
person or office
to contact.”
Selecting the
checkbox displays
Name of person or
office, Title or
department,
Phone, and
Extension text
entry fields.
Extension
(optional)
Entity
Beside “Phone”
Registration –
(Your Point of
Contact on
NPDB
Reports)
Text Entry The field is
displayed if the
user selects the
radio button
for “I will assign
a specific
person or office
to contact.”
Selecting the
checkbox displays
Name of person or
office, Title or
department,
Phone, and
Extension text
entry fields.
Description
Entity
Registration
Text
Entry
Below Select up
to 5 actions
The field is
displayed if the
user selects an
adverse action
that requires a
description.
State Changes
Label
PDF Name
Item Type
Trigger
OMB Number: 09150126 Expiration Date:
mm/dd/yyyy
Entity
Registration
Modal
When the user selects the link the modal is
displayed with the public burden statement
content.
Is your organization
already registered
with the NPDB?
Entity
Registration
Modal
When the user selects “Request another
DBID my organization’s NPDB account” for
“Register my organization”
I am authorized by my Entity
organization to serve Registration
as the certifying
official
Check Box Selecting the checkbox hides the fields for
the Certifying Official’s Information (First
Name, Middle Name, Last Name, Suffix,
Title, Phone, Extension, Email Address,
Employee ID).
Password
Requirements
Info box
Entity
Registration
When the user sets focus on the "Create a
new password" text entry, the info box is
displayed. The state of each rule changes
to indicate whether or the rule is met as
the user enters their text.
| File Type | application/pdf |
| File Title | Entity Registration (Initial) |
| Subject | NPDB registration |
| Author | Health Resources and Services Admiistration |
| File Modified | 2020-11-19 |
| File Created | 2020-08-03 |