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Q. |
What
is an NPI? |
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A. |
An
NPI is a 10-digit, intelligence-free numeric identifier. Intelligence-free
means that the numbers do not carry information about healthcare
providers, such as the state in which they practice or their
specialization. NPIs will replace healthcare provider identifiers
that are currently being used for HIPAA standard transactions.
Those numbers include payor-specific IDs and Medicare legacy
IDs (e.g. UPIN, OSCAR, PIN, and National Supplier Clearinghouse
or NSC). A provider's NPI will not change and will remain the
same regardless of job or location. |
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Q. |
Is
a healthcare provider required to obtain an NPI? |
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A. |
Yes.
Under the NPI Regulation (published in the Federal Register
on January 23, 2004), a healthcare provider who is a covered
entity, as defined at 45 C.F.R. § 160.103, and who transmits
any health information in connection with a standard transaction,
is required to obtain an NPI. |
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Q. |
Why
do healthcare providers need NPI numbers? |
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A. |
HIPAA
required the adoption of a standard identifier to allow for
simpler electronic transmission of HIPAA standard transactions
and more efficient coordination of benefits transactions. By
May 23, 2007, the NPI will be the only healthcare provider identifier
used for identification purposes in standard electronic transactions
by covered entities. |
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Q. |
How
can healthcare providers obtain an NPI? |
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A. |
Providers
who have not yet obtained their NPI may apply for it in one
of the following ways:
- A
web-based application that takes about 20 minutes to complete
online at https://nppes.cms.hhs.gov.
- A
paper application that may be downloaded from https://nppes.cms.hhs.gov,
or you can call the NPI Enumerator call center at 800.465.3203
to request a paper application.
- An
electronic file submitted by an organization. You must have
the healthcare provider's permission to apply for an NPI
by this method.
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Q. |
How
many NPI numbers do healthcare providers need? |
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A. |
An
individual is eligible for a single NPI. An individual
cannot have subparts and cannot designate subparts. In terms
of NPI assignments, an individual is an Entity Type 1 (Individual).
A
sole proprietor/sole proprietorship is eligible for a single
NPI. A sole proprietor/sole proprietorship cannot have
subparts and cannot designate subparts. In terms of NPI assignment,
a sole proprietor/sole proprietorship is an Entity Type I
(Individual).
Organizations
must also apply for a single NPI. In terms of NPI assignment,
organization healthcare providers who are covered entities
under HIPAA must apply for NPIs as Entity Type 2 (Organizations).
Organization healthcare providers are corporations or partnerships
or other types of businesses that are considered separate
from an individual by the state in which they exist. Subparts
of such organization healthcare providers who apply for NPIs
are also Entity Type 2 (Organizations).
A
subpart must have its own NPI if it conducts any HIPAA standard
transactions separately from the covered organization healthcare
provider of which it is a part. If your organization has subparts,
make sure they obtain their own unique NPIs or get the NPIs
for them. For further clarification about entity types and
subparts, visit the Centers for Medicare and Medicaid Services
(CMS) website at http://new.cms.hhs.gov/NationalProvIdentStand.
Select the Medicare NPI Implementation link and then the Medicare
Subpart Expectations PDF.
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Q. |
What
is my Primary Provider Taxonomy Code? |
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A. |
The
Provider Taxonomy is an alphanumeric code, 10 characters in
length that allows a single provider (individual, group or institution)
to identify the specialty category. For more information, visit:
http://www.wpc-edi.com/taxonomy. |
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Q. |
How
long will it take to receive an NPI? |
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A. |
CMS
cannot predict the amount of time it will take to obtain an
NPI due to several factors-such as the volume of applications
being processed, how the applications are submitted and if the
applications are complete and free of errors. CMS estimates
that, in general, a healthcare provider who submits a properly
completed electronic application could have an NPI within 10
days. |
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Q. |
How can healthcare providers report NPIs to First Choice? |
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A. |
You
should report your NPIs to First Choice by completing and returning
the First Choice National Provider Identifier
Submission Form. Instructions for faxing or mailing are on the
form. |
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Q. |
Where
can I find more information about the NPI? |
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A. |
Visit
the CMS website, http://new.cms.hhs.gov/NationalProvIdentStand,
for additional information. |
