Before we take your question, let us understand what is NPI? NPI is known as National Provider Identifier. It is an Administrative Simplification mandate of HIPAA. NPI is a 10 digit unique number that will be used to identify you to
your health care partners, including all payers, in all HIPAA standard transactions.

There are two types of NPI and these are as follow:-

Type 1

Type 1 is for those health care services work solo and these are physicians, dentists, and all sole proprietors. A solo individual will be eligible for only 1 reverse NPI lookup.

Type 2

Organizations that are health care providers, including medical associations, hospitals, and nursing homes are of type 2.

Would I ever need to get a New NPI?

No, NPI is forever like a diamond. It will remain unchanged even if the health care servicer changes his or her details. If you need to update any information then you can do that too. The only chance you have to obtain a new NPI is if the original one has been used fraudulently.

 

Who May Obtain an NPI?

An NPI can be received by all health care providers (that is, doctors, manufacturers, hospitals, and others). Health care providers are persons or entities that provide health care as specified in 160.103 of the 45 Code of Federal
Regulations (CFR).

Who Must Obtain an NPI?

All health care services that are HIPAA-covered entities, whether individuals or organizations, must obtain an NPI.

Below we have mentioned HIPAA covered entities:-

• Health care servicer that performs certain transactions in electronic form

• A Health care clearinghouse

• A Health plan (including commercial plans, Medicare, and Medicaid)

Under HIPAA, if you transfer health information electronically per a HIPAA standard transaction, even if you use a business associate to do so you are a covered health care provider.

 

Think You Don’t Need An NPI? Think Again

 

According to HIPAA if you are a covered entity or business associate then you must have an NPI even if you do not bill for services, you may need to disclose your NPI to those providers who do. Claims may be negatively affected
without the NPI, with reimbursement deferred or likely refused.

Conclusion

It is mandatory to have an NPI. Although to get an NPI is a very simple process and it won’t take much of your time. After you apply online it will only take 5 to 7 days to get NPI.

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