How to get a National Provider Identifier (NPI) if you don’t have a Social Security Number (SSN)

In most cases, you either need a Social Security Number (SSN) or US-issued Individual Taxpayer Identification Number (ITIN) to obtain an NPI. In most cases, international residents will need an NPI before they receive an SSN or TIN. So how do you get an NPI without a Social Security Number? The Centers For Medicaid & Medicare Services (CMS) has granted international residents an exception to apply for the NPI without SSN or ITIN. As an international resident, you will need to follow steps to obtain your NPI.

get a National Provider Identifier (NPI)

3 Steps to receive your NPI

1) Completed, sign and date an

NPI Application/Update Form (CMS-10114)
Carefully read the instructions on the NPI Application/Update Form (CMS-10114) to ensure that there are no errors or information left out that may result in your form being rejected. Also, make sure you sign and date the form before submitting it.                                                                                                                                        Below are some common mistakes that can result in your application being rejected:                                                                                                          

Remember to select an entity type:

  • Entity Type 1, health care providers who are individuals need to complete sections 2A, 3, 4A, and 5.
  • Entity Type 2, health care providers who are organizations or subparts, need to complete sections 2B, 3, 4B, and 5.

Do not staple the application pages together

Print legibly or type your application

Include an original signature of the health care provider and a telephone number on the application. Do not send a photocopy of the signature or an application with a stamped signature. The name in the signature must match the name of the provider.

Application original signature

2) Copies of two proof of identification documents
US-issued identification is usually required as one of the forms of identification; however, an exception has been made for international residents and fellows. Below are acceptable documents you can use for proof of identification:

  • Birth certificate
  • Passport biographical data page (the page with your photo and personal information)
  • S. driver’s license (if you have been issued one)
  • US-issued State identification card (if you have been issued one)

* An English translation of all documents that are not in the English language is required to be submitted with the identification documents.

3) Letter of explanation
The Letter of Explanation should include your anticipated program start and end dates and a brief description of the residency program you are participating in. The letter must also include an acknowledgment that the provider understands that they must keep the NPI Enumerator informed of any changes to the information provided within 30 days from the effective date of the change.

letter of explanation

A sample Letter of Explanation can be found below. In the sample letter, delete any text before sending it.





NPI Enumerator
P.O. Box 6059
Fargo, ND 58108-6059


Dear NPI Enumerator:

I am requesting an NPI number. My completed CMS-10114 application with all supporting documents is attached for your review.  Please note that I do not have a U.S. Social Security Number as I have not yet met the immigration requirements needed to obtain one.


I will not meet those requirements until I am admitted into the United States by U.S. Customs & Border Protection, and I intend to arrive in the USA on [date of arrival].

I have applied for an SSN and am still awaiting a Social Security Administration response regarding my application.

I am in the USA but cannot apply for an SSN until I obtain employment authorization from USCIS.   I expect to have employment authorization by [insert date] but must have an NPI number by that date to properly begin my residency program.

I will be a Resident with [NAME OF RESIDENCY/FELLOWSHIP PROGRAM].  The program will begin [insert date] and end on [insert date].  A brief description of the residency program follows:


As a provider, I fully understand that I will need to keep the NPI Enumerator informed of any changes to the information provided on the NPI Application within 30 days of the date the changes take effect.  I also understand that I must provide the NPI Enumerator with my SSN within 30 days of the date it is received.

Thank you for your favorable review of my NPI application and supporting documents.  Please feel free to contact me should you have additional questions or concerns.


Sincerely yours,