What is the National Provider Identifier (NPI) Registry?

The National Provider Identifier, NPI, is a crucial part of any healthcare provider’s professional identity. But what is NPI, how is is used, and how do you apply? We answer your top NPI questions below.

What is an NPI number?

An NPI number is a 10-digit numerical identifier used to identify an individual provider or health care entity. It is shared with other providers, employers, health plans, and payers via the NPI registry.

There are two types of number assignments: Type 1 providers, and Type 2 providers. Type 1 includes individuals such as sole proprietors, dentists, physicians, surgeons. A provider is eligible for a single number. Type 2 NPI are organizations and may include acute care facilities, health systems, hospitals, physician groups, assisted living facilities, and health care providers who are incorporated.

What is the NPI Registry?

The National Provider Identifier Registry is a free public search directory managed by the US federal government. All active NPI records can be accessed through the registry by any individual. Information including the provider’s role, NPI number, and primary practice address will be displayed in the NPI.

What is the Purpose of Having an NPI Number?

An NPI number is a mandatory component of HIPAA-standard administrative and finance transactions. The NPI was created as part of the Health Insurance Portability and Accountability Act (HIPAA) in 2004 to help send health information safely and effectively.

Here are some common NPI use cases:

• Payment and remittance advice
• Claims status
• Coordination of benefits
• Claims and encounter information
• Eligibility, enrollment and disenrollment
• Referrals and authorizations
• Premium payment

Who needs an NPI number?

If you are a HIPAA-covered provider or if you are a health care provider or supplier who bills federally funded programs for your services, you must have an NPI number. Providers need an it prior to enrolling with Medicare.

The assignment of an NPI Number is not required for a provider to practice medicine. A health care provider who is HIPAA non-covered, has opted out of Medicare/Medicaid, and/or takes absolutely no third-party payments does not need to get one.

While the above MUST get an NPI, all healthcare providers MAY  apply for an NPI.

What does an NPI number do?

Having a national standard for electronic health care transactions simplifies the processes and reduces the administrative burdens on health care providers. They also serve as industry standard identifiers of healthcare providers. Importantly, they do not verify if an individual is actively credentialed or licensed in their operating area.

How do you apply for an NPI number?

To complete the online application, you must first obtain an Identity & Access (I&A) User ID. You may obtain this User ID by accessing https://nppes.cms.hhs.gov and completing steps 1-4 below:

• Select the Create a Login link on the Individual Provider side of the National Plan and Provider Enumeration System (NPPES) home page.

Note: You will be redirected to the I&A website.

• Follow the steps to complete your I&A Registration.

• Once you have successfully obtained an I&A User ID, you may return to the NPPES Home page and log into the NPPES website with your newly created I&A User ID.

• Select the Submit a New NPI Application to begin the NPI application process.

How much does a NPI number cost?

You can obtain an NPI free of charge by applying online or by contacting the NPI Enumerator to request a paper application. The approval process for online applications typically takes only a few minutes. And they say nothing is free anymore!

When is the NPI registry updated?

The information in the NPI database is typically updated manually or if you apply for another number. (Note: Individual providers can only have NPI, but organization providers may apply for multiple NPIs).

It will not update automatically. So, if you get a new state license or leave a residency or fellowship, “it” will not know. Like LinkedIn, providers need to edit their profile to keep it up-to-date.

What information can you find in the NPI Registry?

The NPI registry contains the provider’s NPI number, name, licensure, practice status, and much more. Here’s a quick rundown of the information included.

Provider Name:

The provider name, as well any aliases, including maiden names, or other legal or professionals names associated with the provider, are included. You can also search the registry by any part of the provider name.

NPI number:

The provider’s unique 10-digit NPI number is one of the core purposes of the NPI registry, and is always included below the provider name.

Status:

The NPI  registry will indicate whether or not the provider is currently active.

Practice Address:

The provider’s practice address and mailing address are both included. They can be the same address or two unique addresses.

Enumeration Date, Last Updated Date, and Certification Date:

The enumeration date is the day the NPI number was assigned. The last updated date reflects when the NPI profile was last updated. The certification date will reflect the date of the most recently updated certification in the NPI profile.

If you get a new license, do you need to manually update your NPI number?

Yes. If you want your NPI profile to reflect your new licensure, you must log into the NPI database and input it yourself. Given the importance of NPI to operating as a health care provider, most providers are recommended to input their new information into the NPI registry immediately.

Is an NPI Number the Same as a License Number?

An NPI number is entirely distinct from a provider’s license number and serves a different purpose. The license number is assigned by the state governmental agency that regulates the healthcare provider. However, a provider’s license number is included in the NPI registry.

Will my NPI number change?

Once a provider receives their number, it will not change regardless of if you change your job or location. The NPI is designed to follow a provider throughout their career regardless of life and professional changes, but in special circumstances, a provider’s NPI can be changed.  An employee of the CMS National Plan and Provider Enumeration System can assist you in those extreme instances.

When can I get an NPI number?

You need to apply for an NPI number prior to your enrollment in Medicare. Medicare will reject your application if you do not already have an active number. You must have an it if you are a HIPAA-covered entity.

A HIPAA-covered entity is a:

● Health care provider that conducts certain transactions in electronic form

● Health care clearinghouse

● Health plan (including commercial plans, Medicare, and Medicaid)

Under HIPAA, you’re a covered health care provider if you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so.

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