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.