The NPI is the standard unique health identifier for health care providers. The NPI was mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Providers may request an NPI electronically at the following site: https://nppes.cms.hhs.gov/.
Please note that electronic applications allow providers to supply and identify current proprietary identifiers of multiple payors. As many providers provide service to insureds covered by multiple related payors such as multiple state Medicaid’s it is important to associate each proprietary identifier with an individual state.
Individuals identified in any covered electronic healthcare transaction must obtain an NPI that remains associated with the individual for life. All healthcare providers, defined under the regulation as providers who access claims information or benefits via the Internet are also covered entities.
The broad definition of healthcare "provider" provided in the regulation encompasses all who provide healthcare services: individuals (including physicians and all other practitioners) as well as organizations (such as hospitals, pharmacies, clinics and medical supply companies).
Legal entities must obtain at least one NPI. The organization may obtain additional NPI’s through enumeration of subparts.
Yes. If you have a practice association (PA) or a limited liability corporation (LLC), and it holds any contracts with payers, or if payment is ever made to the PA or LLC, or in the name of the PA or LLC, then it needs to acquire a Type 2 NPI in addition to your individual Type 1 NPI.
Even if the practice association is an S corporation or a "disregarded entity" (i.e., tax return can be filed in the physician's name), the above applies. From an NPI perspective, an S corporation is no different from a limited liability corporation or any other type of corporation; if the PA receives payments, it must have its own Type 2 NPI.
The number (NPI) is 10 positions (9 plus the check-digit) all numeric.
The NPI does not convey information about the provider. Accordingly, providers do not have to change NPI when they change geographical locations or change their type of entity.
• Inclusive information on the NPI is available from CMS at http://www.cms.hhs.gov/NationalProvIdentStand or you may call The CMS HIPAA hot line at 1-800-465-3203.
• CMS NPI Viewlet provides an overview of the NPI, a walkthrough of the NPI application process and a live link to the NPPES website. The Viewlet is available under the above website. Just look under Educational Resources.
• Medicaid will post information regularly at http://www.emedny.org and share information in the Medicaid Update publication.
• Additional questions should be referred to the CSC call center at 800-343-9000.