Blue Shield Application Upload Fax or Upload your Blue Shield Application to Bridlewood Corporate for review. Fax: 815-572-0924 Blue Shield - Agent Application Upload Agent Name(Required) Agent Email(Required) AGENT PERSONAL NPN #(Required) Producer ID(Required) *** AGENT PERSONAL NPN # - Please provide your personal NPN #, NOT your corporate NPN # in this field. Blue Shield only allows for ONE corporation to be listed, which is Bridlewood's EIN #, and ONE individual/agent. IF you list your corporate NPN #, the commission will not be paid to the agent, and Bridlewood will not be credited for the business. Thank you. *** Blue Shield Application(Required) Drop files here or Select files Accepted file types: pdf, Max. file size: 50 MB. Comments for Bridlewood Staff