nsridian Healthcare Solutions November 9, 2015 TRINA HEALTH OF MONTANA LLC 530 MONTANA ST DILLON MT 59725-3315 Reference 724214327 Dear TRINA HEALTH OF MONTANA LLC, We are pleased to inform you that your initial Medicare enrollment application is approved. Listed below are your National Provider Identi?er (NPI) and Provider Transaction Access Number (PTAN). To start billing, you must use your NPI on all Medicare claim submissions. Because the PTAN is not considered a Medicare legacy identi?er, do not report it as an ?other? provider identi?cation number to the National Plan and Provider Enumeration System (NPPES). Your PTAN has been activated and will be the required authentication element for all inquiries to customer service representatives (CSRs), written inquiry units, and the interactive voice response (IVR) system. The IVR allows you to inquire about claims status, bene?ciary eligibility and transaction information. If you plan to ?le claims electronically, please contact our JF EDI department at 877-908-8431. Medicare Enrollment Information Supplier name: TRINA HEALTH OF MONTANA LLC National Provider Identi?er (NPI): 1346637683 Provider Transaction Access Number (PTAN): M011006777 Specialty: Group Effective date: September 1, 2015 Electronic Funds Transfer: Will begin on November 2, 2015 You are: Participating Effective September 28, 2015 Practice Location(s) 530 MONTANA ST DILLON MT 59725-3315 Please verify the accuracy of your enrollment information. You are required to submit updates and changes to your enrollment information in accordance with speci?ed timeframes pursuant to 42 CFR ?424.516. Reportable changes include, but are not limited to, 6/75 A CMS Medicare Administrative contractor Norman Healthcale Soluhons LLC 2931?)? (32031443