What is a National Provider Identifier

What is a National Provider Identifier (NPI Number)

The National Provider Identifier, or NPI, is a unique 10-digit identification number assigned to individual healthcare providers.

The National Provider Identifier (NPI) is an Administrative Simplification Standard for the Health Insurance Portability and Accountability Act (HIPAA).

For covered health care facilities, the NPI is a distinctive identification number. In the administrative and financial transactions implemented under HIPAA, covered health care services and all health program and health care clearinghouses must use the NPIs.

NPIs are permanent once assigned and follow the provider regardless of location or work changes.

Type of NPI

There are two categories of health care providers for NPI enumeration purposes: Entity Type 1 (Individual) and Entity Type 2 (Organization).

Entity Type 1 (Individual)

This is needed by Individual healthcare providers, including doctors, dentists, and all sole proprietors.

Entity Type 2 (Organization)

Healthcare providers, including medical associations, hospitals, nursing homes, etc., need Type 2 NPI.

HIPAA Rules for NPI

In the administrative and financial transactions implemented under HIPAA, covered healthcare providers and all insurance plans and healthcare clearinghouses must use NPIs.

What is a National Provider Identifier

As outlined in the 1996 Health Insurance Portability and Accountability Act (HIPAA) Federal Law, covered insurers must also share their NPI with other providers, health plans, clearinghouses, and any agency that may need it for billing purposes.

Who can obtain NPIs

For doctors, pharmacists, physician assistants, midwives, nurses, nurse anesthetists, dentists, chiropractors, clinical social workers, specialist psychologists, physical therapists, occupational therapists, hospitals, home health care providers, nursing homes, residential rehab facilities, labs, pharmacy, and medical equipment firms, NPIs is required.

What you need to apply

You will be asked to list a business mailing address and the NPI application’s clinic location address. If you collect mail at the same place where you train, these addresses will be the same.

Public information on the NPI List on the NPPES site is your company mailing address and practice location, and you can change them at any time.

How long it takes to apply and receive your number

NPPES reports that it takes 10 minutes to complete the online application or 20 minutes to fill out the paper form if you have your registration details ready.

For electronic submissions, the processing period for receiving your NPI is usually one day.

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