Doula Medicaid Enrollment - Upsidian Health

About you

Use your legal name exactly as it appears on your ID. It has to match your documents.

Legal first name *

Enter your legal first name.

Legal last name *

Enter your legal last name.

Email *

Enter a valid email address.

Phone *

Enter a 10-digit phone number.

Date of birth *

Enter your date of birth.

Languages you speak *

List at least one language.

Home address

Street address *

Enter your street address.

City *

Enter a city.

State *

Enter a state.

ZIP *

Enter a 5-digit ZIP.

Your NPI

An NPI (National Provider Identifier) is a free, 10-digit number every Medicaid provider needs. If you don’t have one, we’ll apply for you at no cost to you.

Do you already have an NPI? *

Yes, I have one No, please apply for me

Choose one.

Good news: We’ll submit your NPI application for you. We just need a few more details.

State of birth *

Enter your state (or country) of birth.

Services you provide *

Select all that apply.

Doula Taxonomy 374J00000X Lactation consultant Taxonomy 174N00000X (non-RN)

Select at least one service.

Practice location

This address is public. It will show on the NPI Registry. If you don’t want your home address listed, use a business or mailing address instead.

Use my home address

Street address *

Enter a street address.

City *

Enter a city.

State *

Enter a state.

ZIP *

Enter a 5-digit ZIP.

My mailing address is different Also public on the NPI Registry.

Optional: health information exchange & other IDs

Do you use a secure system to share health records electronically?

Most doulas don’t. If you’re unsure, choose “No / not sure.”

No / not sure Yes

Other provider IDs

For example, a Minnesota Medicaid provider number. Don’t enter your SSN, ITIN, EIN, Medicare or DEA number here.

Medicaid & the Doula Registry

Even if you’re already enrolled as a Medicaid provider, you still need to complete this application. It’s how Upsidian bills for the care you provide.

Are you, or have you ever been, a Medicaid provider in any state? *

Yes No

Choose one.

MDH Doula Registry

Are you listed on the Minnesota Department of Health Doula Registry? *

Yes Not yet

Choose one.

A few required checks

Medicaid requires every provider to answer these. Answer honestly. A “yes” doesn’t automatically disqualify you, and we’ll follow up privately.

Check any that apply

If you haven’t done these yet, that’s okay. Submit anyway and we’ll reach out. We can provide HIPAA training.

I’ve completed HIPAA training and have proof of completion I’ve supported at least three (3) births as a doula

Do any of these apply to you? *

See the full list

Ever suspended from Medicare or Medicaid (any state)
In the past 10 years, convicted of a felony or misdemeanor involving fraud or abuse in a government program
In the past 10 years, found liable for fraud or abuse in a civil case
In the past 10 years, settled instead of being convicted of fraud or abuse involving a government program
Any license, certificate or approval to provide health care ever suspended, revoked or disciplined, for you or your business
Lost or surrendered a license or certificate while a disciplinary hearing was pending
Owe fines or debts related to Medicare, Medicaid or another government health program
Have subcontractors who provide health care services or goods
Significant business transactions with a subcontractor in the past 5 years
Subcontractor transactions over $25,000 related to Medicaid services in the past 12 months

None of these apply One or more apply

Choose one.

Upload your documents

PDF or photo is fine. Up to 5 files each, 10 MB per file. Make sure everything is clear and readable.

Government-issued photo ID *

Driver’s license, state ID or passport.

Add fileNo file yet

Upload your ID.

CPR certification *

Must cover adult AND infant CPR, from the American Red Cross or American Heart Association.

Add fileNo file yet

Upload your CPR certification.

Doula certification *

Certificate or proof you completed training.

Add fileNo file yet

Upload your doula certification.

Proof of liability insurance *

Add fileNo file yet

Upload proof of liability insurance.

Review & sign

Check your answers, then sign below.

Your signature

Everything in this application is true, correct and complete. If anything changes, I’ll tell Upsidian right away. I authorize Upsidian and its billing partner, MINE Maternity, to submit my Medicaid enrollment and health plan applications, and to bill for my services, on my behalf.

Both boxes are required.

NPI application authorization

Read the NPI application terms

I have read the contents of the application and the information contained herein is true, correct, and complete. If I become aware that any information in this application is not true, correct, or complete, I agree to notify the NPI Enumerator of this fact immediately.

I authorize the NPI Enumerator to verify the information contained herein. I agree to keep NPPES updated with any changes to data listed on this application form within 30 days of the effective date of the change.

I have read and understand the Penalties for Falsifying Information on the NPI Application / Update Form as stated in this application. I am aware that falsifying information will result in fines and/or imprisonment.

Penalties for Falsifying Information: 18 U.S.C. 1001 authorizes criminal penalties against an individual who in any matter within the jurisdiction of any department or agency of the United States knowingly or willfully falsifies, conceals, or covers up by any trick, scheme or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry. Individual offenders are subject to fines of up to $250,000 and imprisonment for up to five years. Offenders that are organizations are subject to fines of up to $500,000. 18 U.S.C. 3571(d) also authorizes fines of up to twice the gross gain derived by the offender if it is greater than the amount specifically authorized by the sentencing statute.

I’ve read and agree to the NPI application terms above. I’ve read the NPPES Privacy Statement. I’ve read the NPI Data Dissemination notice. I authorize Upsidian’s billing partner, MINE Maternity, to submit my NPI application on my behalf. I’ve been told how the process works and I consent. I certify this form is completed by, or for, a health care provider as defined at 45 CFR § 160.103 (this includes doulas).

All five boxes are required for us to apply for your NPI.

Type your full legal name *

Type your name exactly as entered in Step 1.

Date

Application received

Thank you. We’ve got it from here.

We’ll review your application and reach out if we need anything. Families begin joining Upsidian in January 2027. Questions? Email doulas@upsidianinc.com.

Serve Medicaid families with Upsidian.

About you

Home address

Your NPI

Practice location

Social Security number

Medicaid & the Doula Registry

MDH Doula Registry

A few required checks

Upload your documents

Review & sign

Your signature

NPI application authorization

Thank you. We’ve got it from here.