What is the NPI Number?
NPI stands for The National Provider Identifier. It is the Administrative Simplification Standard of the Health Insurance Portability and Transparency Act (HIPAA). NPI is a unique identification number for covered health care providers. 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 before enrolling with Medicare.
Generally, there are two types of health care providers in terms of NPIs.
- These are the health care providers who are individuals, including physicians, dentists, and all sole proprietors. If you are an individual then you are eligible for only one NPI.
- Organizations that are health care providers, including medical associations, hospitals, nursing homes, and those organizations that are formed when an individual incorporates him/herself.
You may need to have NPI for yourself if you are a health care provider. Also, if you are incorporated then you need to obtain an NPI for yourself (Type 1) and an NPI for your business or LLCC if you are a person who is a health care provider and who is incorporated (Type 2).
Who Needs an NPI Number?
Any healthcare provider, healthcare clearinghouse, or healthcare agency that does transactions or uses medical records that fall within the scope of the HIPPA Regulations is needed to obtain NPI. This involves agencies and providers who use health billing firms to manage their claims. HIPPA requires that National Provider Identifier be given to any person, business, or health organization that transmits any patient medical information in electronic form in connection with a transaction.
HIPAA-covered providers and organizations include:
- Ambulance companies
- Chiropractors
- Clinical Social Workers
- Clinical Therapists
- Clinics
- Dentists
- Group Practices
- Health care clearinghouses
- Health care plans
- Home health care agencies (HHA’s)
- Hospitals
- Licensed Therapists
- Medical Equipment suppliers
- Medical Laboratories
- Nurses
- Nursing homes
- Opticians
- Optometrists
- Pharmacies
- Pharmacists
- Physical therapists
- Physicians
- Physician Assistants
- Psychologists
- Residential Treatment Centers