The Who, What, When, Why & How of NPI:
Information for Health Care Providers
Who? All Individuals and Organizations who meet the definition of health care provider as
described at 45 CFR 160.103 are eligible to obtain a National Provider Identifier, or NPI. 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.
What? The NPI is a 10-digit number that will be used to identify you to your health care partners, including all payers, in all HIPAA standard transactions. The NPI will replace the identifiers you currently use in HIPAA standard transactions that you conduct with Medicare and with other health plans. You will need an NPI prior to enrolling with Medicare. There are two types of health care providers in terms of NPIs:
- Type 1 — Health care providers who are individuals, including physicians, dentists, and
all sole proprietors. An individual is eligible for only one NPI.
- Type 2 — Health care providers who are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself.
- Organizations must determine if they have “subparts” that need to be uniquely identified in HIPAA standard transactions with their own NPIs. A subpart is a component of an organization health care provider that furnishes health care and is not itself a separate legal entity.
- If you are an individual who is a health care provider and who is incorporated, you may need to obtain an NPI for yourself (Type 1) and an NPI for your corporation or LLC (Type 2).
When? The NPI compliance date is May 23, 2007. It is important that you obtain your NPI now. Once you obtain your NPI and share it with your health care partners (including payers, clearing houses, vendors, and other health care providers), your partners must integrate the NPI into their systems and processes. Also, testing transactions using your NPI with your health care partners may take some time and cannot even begin until after you obtain your NPI. If you delay applying for your NPI, you risk your ability to meet the NPI compliance date and jeopardize that of your health care partners as well.
Why? The NPI is an Administrative Simplification mandate of HIPAA.
How? There are three ways that you can obtain your NPI. You can:
- Complete the on-line application at the NPPES web site;
- Download the paper application form at www.cms.hhs.gov/NationalProvIdentStand/and mail it to the address on the form; or,
- After asking you for your permission, authorize an employer or other trusted organization to obtain an NPI for you through bulk enumeration, or Electronic File Interchange (EFI).
Regardless of how you obtain your NPI, it is important that you retain the notification document that NPPES sends to you that contains your NPI. You may need to share this notification with other health care partners.
More: Go to http://www.cms.hhs.gov/NationalProvIdentStand/ to find additional NPI information.
This sheet was prepared as a service to the public and is not intended to grant rights or impose obligations. This sheet may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the statute or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents.
NPI – Who, What, When, Why & How – Download [Optimized PDF]
NPI – Who, What, When, Why & How – Download