Quick Guide to Understanding National Provider Identifiers

What is a NPI?

NPI or national provider identifier is a unique 10-digit identification number representing a distinct health care provider for individuals and organizations alike. With the help of NPI you can simplify the sharing of health care data. A provider’s NPI is linked with information that health insurance entities use to recognize and categorize the category of services they offer. With this information, insurance entities can easily verify the provider’s details and indentify their patients’ claims. This helps patients get reimbursed quicker while reducing the risk of mistakes.

Who needs an NPI?

Any healthcare provider, healthcare clearing house or healthcare agency that performs transactions or uses medical records that fall within the scope of the HIPPA Regulations is needed to obtain National Provider Identifier. If you are a HIPAA covered provider or if you are a health care provider/supplier who bills Medicare for your services, you need an NPI.

HIPAA-covered providers and organizations include:

  • Ambulance companies
  • Chiropractors
  • Clinical Social Workers
  • Clinical Therapists
  • Clinics
  • Dentists
  • Group Practices
  • Health care clearinghouses
  • Health care plans
  • Home health care agencies (HHA’s)
  • Hospitals
  • Licensed Therapists
  • Medical Equipment suppliers
  • Medical Laboratories
  • Nurses
  • Nursing homes
  • Opticians
  • Optometrists
  • Pharmacies
  • Pharmacists
  • Physical therapists
  • Physicians
  • Physician Assistants
  • Psychologists
  • Residential Treatment Centers

There are two types of health care providers in terms of NPIs:

Type 1

Any individual or healthcare provider who do solo practice is eligible for NPI but only one. This healthcare provider can be dentists, physicians or any sole proprietors.

Type 2

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

When NPI came into existence?

The NPI is an Administrative Simplification mandate of HIPAA and its compliance date is May 23, 2007.

How to obtain NPI?

  1. You can complete the online application on the site of NPPES.

Simply download the paper application form and then forward it to the address on the form. You can download the form from www.cms.hhs.gov/NationalProvIdentStand.



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