Rule 23-203-1.1 - Provider Enrollment Requirements for Physicians, Osteopaths, Chiropractors, PodiatristsPhysician providers may participate in the Medicaid program upon compliance with provider enrollment requirements outlined in Part 200, Chapter 4, Rule 4.8 in addition to the specific provider type requirements listed below. Physicians, osteopaths, chiropractors and podiatrists must also meet the specific requirements as follow:
A. National Provider Identifier (NPI), verification from National Plan and Provider Enumeration System (NPPES)B. Copy of licensure card or letter from the appropriate board stating current certification and must be from state of servicing location.C. Verification of social security number using a social security card, driver's license if it notes the social security number, military ID or a notarized statement signed by the provider noting the social security number. The name noted on verification must match the name noted on the W-9.D. CLIA certificate and completed Certification form, if applicableE. Copy of specialty certificate(s), if applicable23 Miss. Code. R. 203-1.1
Miss. Code Ann. § 43-13-121