An NPI is a 10-digit, intelligence-free numeric identifier. Intelligence-free means that the numbers do not carry information about health care providers, such as the state in which they practice or their specialization. NPIs replace other health care provider identifiers that might have been used for HIPAA standard transactions. Those numbers include payer-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.
Yes. Under the NPI Regulation, published in the Federal Register on January 23, 2004, a health care 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.
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. Since May 23, 2007, the NPI is the only health care provider identifier used for identification purposes in standard electronic transactions by covered entities.
Providers who have not yet obtained their NPI may apply for it in one of the following ways:
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 health care 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 health care 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. Select the Medicare NPI Implementation link and then the Medicare Subpart Expectations PDF.
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: https://taxonomy.nucc.org/.
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 health care provider who submits a properly completed electronic application could have an NPI within 10 days.
You should report your NPIs to First Choice by completing and returning the First Choice National Provider Identifier Submission Form.
Visit the CMS website for additional information. You can also call First Choice Provider Services at 1-800-741-6605.
