Before Getting Started:
Find out if you are already enrolled with Oregon Health Authority (OHA).
To do this, use OHA's online tool. Just enter your National Provider Identifier (NPI).
To enroll, you need to know your provider type and specialty code. Use this list to find the codes you need. To find taxonomy codes,
search the NPPES website using the provider's NPI.
Learn How to Enroll, Update Information or Revalidate
Click the boxes below to learn what you need to submit.
For individuals whose services are billed by an organization, search for “Non-Payable Provider." This includes rendering, ordering, prescribing, and referring providers.
For individuals who intend to bill directly for their services, search for “Payable Individual."
For organizations, search for your provider type or provider type number as shown on the Enrollable Provider Types and Specialties list.
Submit updates within 30 days of the change.
For changes in ownership or managing employees:
Search for “Ownership."
If an NPI is changing due to change of ownership, a submit a new enrollment application. Do not submit a change of ownership for an existing enrolled provider.
For other information updates:
Search for “Provider update" to update address, contact information, taxonomy or other information.
We do not need this information for people licensed by the Oregon Medical Board, Oregon Board of Pharmacy, or Oregon Board of Nursing. This is true even if you get a letter asking you to send it to us.
For all other licensed practitioners, fax a copy of the renewed license along with a copy of the license notice received to 503-947-1177 (Salem).
Fee-for Service (FFS) Enrollment Forms and How to Submit
Use only the forms posted below. OHA only accepts previous versions of posted forms for three months after the revision date. For example, if a form is revised in January, OHA will only accept the older version through April.
Use the online request. Before using, review the step-by-step guide.
View the step-by-step guide >>
Go to the online request >>
Do not use the online request for license updates. See the license renewals section of this page for information on how to submit license updates.
All forms are fillable PDFs. If you use Mozilla Firefox, you may need to change your download settings to see the fillable version.
Complete all required forms and save them to your computer or network drive. Make sure each completed form:
- Is a PDF, TIFF or TXT file;
- Is a file size of 10 MB or less; and
- Has a file name that is 256 characters or less.
Fax your application to 503-378-3074. OHA can only accept requests that are under an EDMS coversheet with the “Provider Enrollment" box marked at the top of the coversheet.
- To find the coversheet, search for “EDMS" in the forms search below.
- On the EDMS coversheet, check the "Provider Enrollment" box at the top of the form.
If you fax without an EDMS coversheet, or the “Provider Enrollment" box is unchecked on the coversheet, Provider Enrollment will not receive those requests. To ensure receipt of faxed requests, contact Provider Enrollment at least 48 hours after faxing.