The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims.
NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities use NPIs in standard transactions. You are a covered entity if you conduct any electronic transaction with federal health programs.
Your individual NPI is yours even if your employer files the application for it. The NPI does not change when you change practices or work in different settings. You will have only one individual NPI. It will be used by all health plans who are covered entities, eliminating what are likely many provider numbers assigned by Medicare, Medicaid, and private payers at present.
CMS has created an online NPI registry(nppes.cms.hhs.gov) where a physician, other health care provider, or organization can access NPI information. This is part of the same National Plan and Provider Enumeration System (NPPES) web site on which NPI registry is completed.
Only the health care provider data elements that are disclosable under the Freedom of Information Act (FOIA) are released.
Social Security Numbers (SSNs), Internal Revenue Service Individual Taxpayer Identification Numbers (IRS ITINs) and dates of birth (DOB) are not disclosable under FOIA and, therefore, will not be released to the public.
The CMS NPI Dissemination(www.cms.hhs.gov) has more information regarding the disclosure of NPI information.
If you practice as a sole proprietorship, you must apply as a type I (individual). You will have to submit your social security number rather than your employer identification number (even if you have one).
Eligible organizations, including S corporations, may apply for an NPI as an entity Type II (organization). Eligible individuals working within an organization, including an S corporation, may also apply for an NPI as an entity Type I (individual). An S corporation representing only one practitioner is still eligible for a Type II NPI. From an NPI perspective, an S corporation is no different than a limited liability corporation or any other type of corporation.
You can apply for an NPI in one of three ways:
The fastest and easiest way for most physicians will be completing the online application form.
Complete the application online. You will need:
If you have someone other than yourself complete the application, they will also need to know in what country and state you were born, your date of birth, and your social security or individual taxpayer identification number.
If you wish to complete a paper application/update form (CMS-10114), this must be obtained by contacting the NPI Enumerator. After receiving the form, mail applicaton completed and signed to the NPI Enumerator located in Fargo, North Dakota, whereby staff at the NPI Enumerator will enter the application data into the enumeration system. The form will be available only upon request through the NPI Enumerator. Health care providers who wish to obtain a copy of this form must contact the NPI Enumerator in any of these ways:
Electronic File Interchange (EFI), also referred to as bulk enumeration, is a process by which physician and other health care providers (hereinafter simply referred to as provider) or group of providers can have a particular organization (the EFIO) apply for NPI on their behalf. In other words, rather than a provider or group of providers submitting a paper or web NPI application, the EFIO obtains an NPI for him/her/them.
What makes EFI so unique is that one file can contain hundreds or thousands of providers' applications. By submitting these applications both simultaneously and electronically, the administrative and financial burdens for both the provider community and the U.S. Department of Health and Human Services (HHS) are greatly reduced. These benefits are enhanced because EFI can also be used to change or update a provider's existing NPI information.
See the CMS Electronic File Interchange Summary(www.cms.hhs.gov) for more information on the EFI process.
Physicians may report primary and secondary taxonomy codes in the NPI application. For instance, a family medicine physician specializing in adolescent medicine might report a primary code for family medicine, 207Q00000X, and a secondary code for adolescent medicine, 207QA0000X.
For family nurse practitioners, the taxonomy code is 363LF0000X.
For family medicine clinical nurse specialist, the taxonomy code is 364SF0001X.
Physician assistants in the medical practice are assigned taxonomy code 363AM0700X.
For students, taxonomy code 390200000X is assigned.
Interns should report the general practice taxonomy code 208D00000X.
Residents should report the taxonomy code for the specialty of the residency program.
If applying for an NPI for an organization, a group taxonomy code may be required. For taxonomy codes, a group practice is defined as a business entity under which one or more individuals practice. A group does not require multiple professional providers.
A single provider group is a valid group and would be identified by the business entity name. For example, John Doe, PC. For single specialty groups, the taxonomy code is 193400000X. For multispecialty groups, the taxonomy code is 193200000X.
You must notify the enumerator of any changes within 30 days of the change. Most changes will not change your NPI number. Only rare circumstances such as fraudulent use of your NPI number will require that you be issued a new number.
You can change the information in your NPI file online(nppes.cms.hhs.gov). You may either create a user ID or, if you have one already, log in and update your information. Download the form(www.cms.gov) to make your change by mail.
Yes. Like UPIN numbers that were used prior to the establishment of the NPI, other physicians and providers to whom you refer will need your NPI number in order to submit claims for services for patients you refer to them.
If another party does billing on your behalf, that party will need your NPI.
You may also need NPI numbers from hospice and home health agencies and other physicians in order to bill for your services.
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National Provider Identifier