W9 Submission Form Is this your first time billing to NHPRI?*YesNoAttach file W9*Accepted file types: pdf, Max. file size: 10 MB.How are you billing?*Professional CMSInstitutional UB-04Full Facility Name* NPI Group* Tax ID* Pay To Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*Provider Email* NotesRendering Practitioner Name* Rendering Practitioner NPI* This process is for Providers who are not in network with NHPRI. If your group participates with us, please call your Provider Network Administrator for assistance. This process is not for claim submission, it is only for Provider setup. Should you need to submit claims please submit electronically or mail to our claims address PO Box 28259 Providence, RI 02908. Submission of this information does not guarantee claims payment.