National Provider Identifier Number FAQs (NPI Registry)

As a non-healthcare worker, we were curious what exactly went into an NPI number. 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 used for?

A unique NPI identifier is used for  for HIPAA-standard transactions. Here are some examples:

• Payment and remittance advice
• Claims status
• Coordination of benefits
• Claims and encounter information
• Eligibility, enrollment and disenrollment
• Referrals and authorizations
• Premium payment

What is an NPI number?

An NPI number is a 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 providers, and Type 2 providers. Type 1 includes individuals such as sole proprietors, dentists, physicians, surgeons. A provider is eligible for a single number. Type 2 NPI 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 NPI 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, you must have an NPI number. Providers need an it prior to enrolling with Medicare.

The assignment of an NPI 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 NPI number do?

Having a national standard for electronic health care transactions simplifies the processes and reduces the administrative burdens on health care providers.

How do you apply for an NPI number?

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 NPI application process.

How much does a NPI number cost?

You can obtain an NPI 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 NPI 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:

• NPI 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 NPI 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 NPI 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 it 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.

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