NPI Facts
What is a National Provider Identifier?
The NPI is a 10-digit, intelligence free numeric identifier (10
digit number). Intelligence free means that the numbers do
not carry information about health care providers, such as the
state in which they practice or their provider type or
specialization.
The NPI will replace health care provider identifiers in use
today in HIPAA standard transactions. Those numbers include
Medicare legacy IDs (UPIN, OSCAR, PIN, and National Supplier
Clearinghouse or NSC).
The provider's NPI will not change and will remain with the
provider regardless of job or location changes.
Having an NPI does not:
- Ensure a provider is licensed or credentialed.
- Guarantee payment by a health plan.
- Enroll a provider in a health plan.
- Turn a provider into a covered provider
- Require a provider to conduct HIPAA transactions.
Why do we need the National Provider Identifier?
- Simpler electronic transmission of HIPAA standard
transactions
- Standard unique health identifiers for health care providers,
health plans, and employers
- More efficient coordination of benefits transactions.
Who can apply for the NPI?
All health care providers (e.g., physicians, suppliers,
hospitals, and others) are eligible for NPIs. Health care
providers are individuals or organizations that render health
care.
If a health plan (such as an MCO) has to be identified as a
healthcare provider in a standard transaction, they would be
eligible for an NPI. However, MCOs will not need to apply for
and use an NPI for standard transactions sent to the IHCP.
All health care providers who are HIPAA-covered entities,
whether they are individuals or organizations must obtain an NPI to
identify themselves in HIPAA standard transactions.
Most individuals and small businesses will have only one
NPI. There are two groups of providers, individuals and
organizations.
Individual Providers
Note: The following list is only a sample of individual provider
types.
- Physicians
- Nurses
- Dentists
- Psychologists
- Physical Therapists
Individual providers who are sole proprietors can only obtain
one NPI. An individual provider who works in a group
practice or clinic may need to obtain an NPI for himself or herself
and a separate NPI for the group practice or clinic.
This is a personal number that remains with the provider for
life.
Organization Providers
Note: The following list is only a sample of organization
provider types.
- Hospitals
- Clinics
- Nursing homes
- Ambulance companies
- Group practices
- Pharmacies
Organization providers may have the option to obtain more than
one NPI. Some components or 'subparts' of an
organization may be eligible to obtain separate NPIs.
Examples of Subparts
- Certified separately
- Licensed separately by the State
- Required by Federal Regulations to have their own billing
number
Organization providers may have the option to obtain more than
one NPI. Some components or 'subparts' of an
organization may be eligible to obtain separate NPIs.
What is a HIPAA-covered health care provider?
It is a health care provider who transmits any health
information in electronic form in connection with a transaction for
which the Secretary of HHS has adopted a standard, even if the
health care provider uses a business associate to do so. Go to the
CMS site to access a tool to
help establish whether one is a covered entity.
Who cannot receive an NPI?
Atypical providers are not eligible to receive an NPI. An
atypical provider is any entity that does not meet the definition
of a "health care provider" at 45 CFR 160.103, This includes but is
not limited to billing services, value-added networks, re-pricers,
health care clearinghouses, non-emergency transportation services,
and others.
How do i get an NPI?
See the Getting and Reporting an
NPI page.