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Welcome to the Rhode Island Medicaid Online Provider Enrollment Process

Please complete each step in the enrollment process. When you have completed all steps of the application, "submit" and "confirm" the application for further processing by the Rhode Island Medicaid Program.

You will need the following information to complete your enrollment request:

  • National Provider Identifier
  • Address Information including Postal Code + 4
  • Taxonomy Codes
  • Tax ID - either EIN or SSN
  • License Number
  • Completed application, including signature, W-9 as an attachment
  • Additional Federally Required Disclosures, as an attachment, if applicable

Please click the "Continue" button to start the enrollment application.

 R4.3.33
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