Blue Cross Blue Shield of Illinois - Network Data Access Services (NDAS) Online Enrollment

Network Data Access Services (NDAS) Online Enrollment

Network Data Access Services (NDAS) Online Enrollment

To be eligible for NDAS Online you must have a valid National Provider Identifier (NPI). Please complete one form for each site (separate facility) utilizing a different organizational (Type 2) NPI. Processing time is 2 - 3 weeks. Your enrollment document will be sent via e-mail.

Site Information
* indicates a required field

*Provider/Site Name

*Street Address

Address Line 2

*City/*State/*Zip:

/ /

*Contact Name:

*Contact Phone

/ /

*Contact Fax

/ /

*Contact E-mail

*Site NPI Number (Type 2)
NPI must be 10 digits.
Example: 1234567890

*Number of User IDs Requested

If you wish to access information for multiple providers, enter each provider's name, individual (Type 1) NPI, and Tax ID Number below:

Provider
Name

NPI
(Type 1)

Tax ID
Number