02/18/2025
The Who, What, When, Why & How of NPI:
Information for Health Care Providers
Who? All Individuals and Organizations “including researchers” who meet the definition of health care provider are eligible to obtain a National Provider Identifier, or NPI. If you are a HIPAA covered provider or if you are a health care provider/supplier who bills Medicare for your services, you need an NPI.
What? The NPI is a 10-digit number that will be used to identify you to your health care partners, including all payers, in all HIPAA standard transactions. The NPI will replace the identifiers you currently use in HIPAA standard transactions that you conduct with Medicare and with other health plans. You will need an NPI prior to enrolling with Medicare. There are two types of health care providers in terms of NPIs:
Type 1 — Health care providers who are individuals, including physicians, dentists, researchers and all sole proprietors. An individual is eligible for only one NPI
Type 2 — Health care providers who are organizations, including physician groups, hospitals, nursing homes, or research groups and the corporation formed when an individual incorporates him/herself. Organizations must determine if they have “subparts” that need to be uniquely identified in HIPAA standard transactions with their own NPIs. A subpart is a component of an organization health care provider that furnishes health care and is not itself a separate legal entity.
If you are an individual who is a health care provider and who is incorporated, you may need to obtain an NPI for yourself (Type 1) and an NPI for your corporation or LLC (Type 2).
When? It is important that you obtain your NPI. Once you obtain your NPI and share it with your health care partners (including payers, clearing houses, vendors, and other health care providers), your partners must integrate the NPI into their systems and processes. Also, testing transactions using your NPI with your health care partners may take some time and cannot even begin until after you obtain your NPI. If you delay applying for your NPI, you risk your ability to meet the NPI compliance date and jeopardize that of your health care partners as well.
Why? The NPI is an Administrative Simplification mandate of HIPAA.
How? There are three ways that you can obtain your NPI.
A. You can: Complete the on-line application at the NPPES web site; https://NPPES.cms.hhs.gov/NPPES/Welcome.do; Download the paper application form at www.cms.hhs.gov/NationalProvIdentStand/ and mail it to the address on the form; or, after asking you for your permission, authorize an employer or other trusted organization to obtain an NPI for you through bulk enumeration, or Electronic File Interchange (EFI).
Regardless of how you obtain your NPI, it is important that you retain the notification document that NPPES sends to you that contains your NPI. And remember it is an Opportunity for one that wants to follow up.