Application for a Medicare provider number 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.

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.

To fill in this form digitally you will need a computer and Adobe Acrobat Reader, or a similar program. You can download Adobe Acrobat Reader for free. If you can’t complete the form digitally, you can print it, complete it by hand and return it to us following the instructions on the form.

If you have a disability or impairment and use assistive technology, you may not be able to access our forms. If you can’t, please contact us. We can help you access, complete and submit them.

Page last updated: 2 March 2023.