A National Provider Identifier (NPI) is a unique ten-digit identification number required by HIPAA for covered health care providers in the United States. Covered providers, health plans, and health care clearinghouses (public or private entities that process or facilitate the processing of health information) must use NPI in administrative and financial transactions adopted under HIPAA.
What is the purpose of an NPI?
The sole purpose of this number is to facilitate organization and create national standards within HIPAA transactions; however, it is possible to use a provider’s NPI to look up information on their National Plan and Provider Enumeration System (NPPES). The NPI itself is an “intelligence-free” number: it does not carry any personal identification of the holder other than the name and business address. Having an NPI does not guarantee that a provider is licensed, but all licensed providers must have an NPI.
How did the NPI come about?
The NPI was born as part of the HIPAA administrative simplification standards for information transactions and data elements. HIPAA requires the Secretary of the Department of Health and Human Services to adopt criteria for a standard unique identifier for each individual, employer, health plan, and health care provider for use in the health care system. The NPI replaces the Unique Physician Identification Number (UPIN), a six-character identifier that Medicare uses to determine doctors in the US who have accepted Medicare insurance. The UPIN was discontinued in June 2007.
Who must obtain an NPI?
All individual and organizational health care providers that are entities covered by HIPAA must obtain an NPI.
Who cannot get an NPI?
Entities that do not meet the definition of a health care provider as defined by HIPAA may not request an NPI.
What are the health care provider NPI categories?
There are two categories of health care providers for NPI enumeration:
Individual or Type 1. This category includes people who provide health care services, such as doctors, nurses, dentists, pharmacists, and exclusive providers.
Organization or Type 2. This category includes organizations that provide health care services or provide health care supplies to patients, such as hospitals and home health agencies.
Frequent questions
I submit paper claims and do not use the Internet to verify patient eligibility or benefits. Do I still need an NPI?
If you do not conduct electronic transactions governed by the Health Insurance Portability and Accountability Act (HIPAA), you are not required to obtain an NPI. However, we suggest you get one as you can use it as a unique and unique identifier with all payers.
How is the NPI determined?
The National Plan and Provider Enumeration System (NPPES) is responsible for issuing NPIs. The NPI contains no embedded data, that is, no coding that could identify the dentist’s status or professional license number. It is simply a random number that does not expire.
How will the NPI affect other numbers I have previously used?
The NPI replaces other identification numbers used in electronic transactions, such as:
- Medicaid
- Blue Cross and Blue Shield
- PUIN
- SHAMPOO
- Another class of “legacy” numbers
The NPI will not replace the following numbers, used for purposes other than general identification:
- Social Security
- DEA
- Tax Identification
- Taxonomy
- State professional license
Where can I get help applying for the NPI?
The NPI enumerator will help you apply and update your information in NPPES.
