It’s important for any healthcare provider working under Medicare and Medicaid to have a clear understanding of the NPI registry and what it requires. But what is the NPI meaning?
NPI stands for National Provider Identifier and is assigned to every healthcare provider to improve efficiency in electronic transmissions. Typically, it’s put on medical bills and claims forms but is also used for other administrative purposes.
This article will cover all the important information healthcare providers need about the NPI and NPPES registry, including NPPES meaning and information about taxonomy lookup.
What is an NPI number?
An NPI number is a unique 10-digit code that’s assigned to medical professionals and organizations. It became a legal requirement with the introduction of the Health Insurance Portability and Accountability Act (HIPAA) and was made the industry standard in 2004.
The Center for Medicare and Medicaid Services (CMS) established the NPPES registry to assign NPI numbers to healthcare providers. NPPES stands for the National Plan and Provider Enumeration System.
The NPI meaning is simply for administrative purposes, and in itself doesn’t carry any information about the medical professional or organization. But an NPI registry combines NPI numbers with this information for convenience when filling out claims forms.
Healthcare providers and organizations working under HIPAA are assigned an NPI number, which remains with them for the duration of their time practicing under the act. It remains the same regardless of changes to role, job, and location.
What is the NPI number used for?
NPI numbers are used on what are known as standard transactions under HIPAA. Generally speaking, these are any forms that a medical professional or organization provides to another organization for admin or billing purposes. Some examples include:
- Claims forms and status inquiries
- Prescription forms
- Patient medical records to identify previous healthcare providers
- General correspondence relating to HIPAA
- Transactions with healthcare plans
An NPI number doesn’t guarantee that a holder is fully licensed to practice medicine, as some healthcare providers (physiotherapists, for example) don’t need a license to provide healthcare services.
Who is eligible for an NPI number?
As is covered in the NPI meaning, the numbers can be assigned to any individual or organization that provides services under HIPAA. Some examples include, but are not limited to:
- Physicians
- Nurse practitioners
- Midwives
- Dentists
- Orthodontists
- Pharmacists
- Counselors
- Occupational therapists
- Chiropractors
Similarly, organizations involved in healthcare services require an NPI number. Some examples include:
- Nursing homes
- Residential care facilities
- Labs
- Hospitals
- Pharmacies
- Medical equipment providers
It’s obligatory under HIPAA that anyone, or any organization, related to Medicare and Medicaid services must have an NPI number to use on communications and transactions. It became a legal requirement in 2004.
To put it another way, if you submit health information associated with HIPAA electronically, such as to medical providers or through a clearinghouse, then you must have an NPI number.
NPI categories
There are two broad categories for NPI numbers, both of which are covered under the NPI meaning. These are:
- Type 1 – individual providers
- Type 2 – organizational providers
Type 1 – Individual healthcare providers
An individual healthcare provider is someone who provides healthcare services as a single entity, including sole providers. For example, this could include a physician who works alone rather than working in a practice with other physicians.
As an individual healthcare provider, you would be assigned a single NPI number. This is unaffected by whether you have other employees or work in different locations. If you’re a sole proprietor, you only get one NPI number.
Type 2 – Organizational providers
An organizational provider can be a single person or a company with hundreds of employees. The difference between type 1 and type for individuals is whether they are a sole proprietor or an incorporated individual. The latter requires type 2.
The main difference with type 2 NPI numbers is that organizations can have several NPI numbers, rather than just one. For an incorporated practitioner, this might mean having one for themselves and another for their corporation.
Similarly, in a large establishment, such as a hospital, different NPI numbers are much more useful. For example, different departments provide different services, and so will bill differently. This means they all need their NPI number.
This is known as a subpart. For example, a lab would be a subpart of a hospital because it provides different services than, say, the emergency room. If a subpart conducts its electronic HIPAA transactions then it needs its NPI number.
How to obtain an NPI number
NPI numbers are organized and assigned through the NPPES registry, which is the government body in charge of this process. While healthcare providers can apply in different ways, the point of the NPPES meaning is that it deals with assigning and recording NPI numbers.
There are three ways to apply for an NPI number:
1. You can apply online directly through the NPPES registry. You must first create an account on the Identity and Access Management System, which can be used to log in. The process takes about 5-10 minutes and your NPI number is assigned shortly after.
2. Download and apply using a paper form. These can be found on the CMS website, printed, filled in and signed. You then send it off to the listed address and will be assigned an NPI number.
3. Allow the Electronic File Interchange Operation to apply for as part of a bulk process. You can find more information about this process on the CMS website.
Before applying for an NPI number, you must first:
- Decide whether you have subparts, and by extension whether you type 1 or type 2.
- If you do have subparts, ensure you apply on their behalf or get them to apply themselves.
- Ensure that your subparts are working in line with the NPI Final Rule.
If you don’t need a medical license to provide healthcare services, for example, if you’re a counselor or physical therapist, the process is only slightly different. You must apply as a student using the code 390200000X.
This is the same process for medical students or those who are currently training to become a licensed medical professional. The NPI number you’re assigned as a student will remain with you once qualified, but your student status will be adjusted.
Watch the video about how to apply for a national provider identifier (NPI).
What is a taxonomy lookup?
NPI numbers are stored on the NPPES registry, but must also be accessible to those outside of HIPAA and medical services. For example, patients may require access to this information when filling out forms or researching new healthcare providers.
For this reason, there is a taxonomy lookup system. This service essentially works like any other searchable database but is for healthcare providers and organizations associated with HIPAA.
Using an NPI registry, you can find the following information:
- Name of practitioner or organization
- State in which they practice
- Medical specialty
This type of information isn’t typically associated with NPI numbers on the NPPES registry, but is linked to them on a taxonomy lookup for convenience.
To find a practitioner on a registry database, you can enter their first name, surname, organization name, and/ or state. The more information you’re able to include, the more accurate the search will be.
Depending on how much information you added, the search will return a list of matching providers. Having information such as their address and specialty will allow you to narrow down your search if you were previously missing this information.
An NPI search database is a useful tool for anyone needing to fill out Medicare and Medicaid electronic forms. This can include patients, healthcare clearinghouses, and insurance providers.
Like the NPI meaning itself, a healthcare provider showing up on a taxonomy lookup doesn’t mean they’re fully licensed to practice medicine. The system is also used for non-licensed practitioners.
Conclusion
Obtaining an NPI number is a fairly simple process, but is necessary if you plan to provide healthcare services under HIPAA. The easiest way to obtain an NPI number is to apply through the NPPES registry; it’s also the quickest way to get your NPI number too.
Using a taxonomy lookup is by far the easiest way to find information about healthcare providers and larger organizations. Although providers have to attach their NPI number to all electronic communications, having a searchable database simply makes things much easier.
