As a non-healthcare worker, we were curious what exactly went into an NPI lookup number listed in the registry for physicians and healthcare providers. And, we got more than expected. Here are the most interesting (we think) facts that we found. What did we miss?
What is an NPI number?
An National Provider Identifier (NPI) is a unique 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 NPI providers, and Type 2 NPI providers. Type 1 includes individuals such as sole proprietors, dentists, physicians, surgeons. A provider is eligible for a single number. Type 2 are organizations and may include acute care facilities, health systems, hospitals, physician groups, assisted living facilities, and health care providers who are incorporated.
Who needs an identification 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, under the Health Insurance Portability and Accountability Act of 1996, you must have an identification number the NPI lookup registry for billing purposes. Providers need an NPI number prior to enrolling with Medicare.
The assignment of a 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.
What does an identification number do?
Having a national standard for electronic health care transactions simplifies the processes and reduces the administrative burdens on health care providers through administrative simplification.
How do you apply for an Idenitifcation number to be listed in the NPI registry?
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 application process.
How much does it cost?
You can obtain a number 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!
Is the NPI database updated?
The information in the database is typically updated manually or if you apply for another number. 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 is held within the NPI Database?
The NPI search database contains the following information:
- National Provider Identification number
- Status
- Provider type
- Type of number
- Enumeration date
- Last updated date
- Licensure
- Hospital affiliations
- Specialties
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 database and input it yourself.
Will my NPI number change?
Once a provider receives their number, it will not change regardless of if you change your job or location.
When can I get an NPI number?
You need to apply for an identification 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 NPI number 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.
If you have a few hours, and are interested in learning how the NPI number is constructed, visit CMS.gov. It’s exhausting.
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