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Five Facts about NPI


What is an NPI?

The National Provider Identification or NPI is a 10 digit, unique identification number used to take the place of provider identifiers such as a Unique Provider Identification number (UPIN) in HIPAA standard transactions. Health care providers are required by regulation of HIPAA to obtain an NPI.

Who Must Have an NPI?

Any health care provider who transmits health information in electronic form must obtain an NPI. There are two categories:

1. Individual
  • Physicians
  • Dentists
  • Nurses
  • Pharmacists
  • Physical Therapists
  • Chiropractors
2. Organization
  • Hospitals
  • Home Health Agencies
  • Ambulance Companies
  • DME Suppliers
  • Nursing Homes

Why You Must Obtain an NPI?

The NPI was established by HIPAA in an effort to help reduce health care fraud. Providers that do not have an NPI will not be able to bill insurance companies or get paid. When completing the UB-04 or CMS-1500, you must enter your NPI in the correct field location in order for your claim to be considered for payment. Most electronic billing software have edits in place to prevent your claim from even billing if you have entered the NPI information in the proper location.

How to Apply for an NPI?

There are three ways to apply for your NPI.

  1. Through the web on the CMS website
  2. Download from the CMS website or call 1-800-465-3203 and request a paper application. Mail your completed application to the NPI Enumerator.
  3. Give permission to an Electronic File Interchange Organization (EFIO) to submit the application on your behalf.

What is the NPI Registry?

Any entity that has been issued an NPI is listed in the NPI Registry.The NPI Registry is an online system that allows a user to search for a health care provider and view the providers information, NPI information, mailing and location address, taxonomy and other identifiers.

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