Application for a Medicare provider number and/or prescriber number for a medical practitioner form (HW019)

Use this form to apply for an initial or subsequent Medicare provider number or a prescriber number, or both.

You must download our forms and fill them in so they are processed quickly. You can also electronically sign some of our forms. We have help available if you use assistive technology.

It’s quicker to create Medicare Provider Numbers (MPNs) using Health Professional Online Services (HPOS) if you’re either:

  • an intern
  • applying for a subsequent provider number.

If you’re a Health Professional applying for your first MPN, you’ll need to apply using a form.

When applying online, you’ll need a PRODA account to use HPOS.

Learn about Applying for subsequent Medicare Provider Numbers and How to apply for a provider number if you’re a medical intern.

If you can’t use HPOS, download and complete the Application for a Medicare provider number and/or prescriber number for a medical practitioner form.

Make sure you submit your application and supporting documentation to us before your proposed location start date.

Page last updated: 23 September 2024.
QC 20526