NPI and its types and their differences

NPI and its types and their differences


Database issues are currently significant challenges for organizations as the administrators have to manage accurate data of organization transactions. In the health care sector, information such as appointments, health plans, medication, transactions, and payment is difficult to manage. Moreover, health care providers experience difficulties sharing their plans and record of patients with another provider. To manage the healthcare sector databases and assist the health care provider, a National Provider Identifier was introduced by the US department of health and human services. This intervention was introduced according to The Health Insurance Portability and Accountability Act of 1996, a legal law to protect patients’ sensitive information. (Jones, 2016)

NPI and its types and their differences

What is HIPAA?

The US department of health and Services introduced The Health Insurance Portability and Accountability Act of 1996 that protects the patient’s information. The individual can also claim their rights if they had experienced any challenges. For instance, there are several cases in which hackers hack the accounts and use their transactions, or sometimes health care providers share the patient information with other health care providers for health plans. Still, the information could not be protected (Richman, 2018). In that case US health and services had created this federal law to protect the patient’s information.

Why was the NPI promoted?

Multiple concerns were recorded in the US health department in which sharing health information and misuse of the patient’s data was recorded. Usually, health care providers require proper plan and treatment records of patients that sometimes patients could not elaborate. For instance, if a general physician refers someone with a brain injury to the neurologist, they will share the NPI to them so they could easily analyze the entire record. In this way, patient’s information will be kept confidential, and no other challenges regarding misuse of information could be considered (Richman E. L., 2020). There are several cases where a patient’s personal identity, bank account, and even address were used that increase the crime rate. Therefore NPI had secured the patient’s information and always make sure that no third party could invade the privacy. Other than this, it was difficult for the administration to manage the patient’s information in hospitals. You might have heard that sometimes administrators have a lot of burden and that wrong slips and payments might happen. However, NPI had assisted the hospital administration in improving their working efficiency to maintain a proper health care system.

Individual National Provider Identifier

The individual NPI refers to the 10 digit codes for a sole proprietor or an individual health care provider. For instance, if a healthcare provider started their private clinic, they require individual NPI or Type 1 NPI. This NPI is attached to the EIN that is the Employer identification number that includes the business taxation.  This identification number interprets an individual as a health care service provider and could provide super billing to the patients to claim reimbursement. However, the patients do not consider individual health care providers if they have to claim reimbursement. (Bhardwaj, 2017)

doctors equipment

Group National Provider identifier

You might have heard the administration transfer the patient’s information to other hospitals or healthcare providers to communicate the information to the administration. A health care administration is responsible for recording patient’s information and manages the databases. However, it sometimes becomes challenging to manage the data. For instance, in the covid-19 pandemic, when health sectors were occupied with patients, administrators have to record the use of ventilators or beds for the patients (Bhardwaj, 2017). For that purpose, health care providers were communicating patients and their requirements, but still, hospital administration was facing challenges. In such cases, NPI could help the health care providers to transmit the patient’s information, and administration could manage the data and use it where they want without fear of losing or security concerns. For that purpose, Group NPI was introduced that is provided to the health care providers working in a team that is in the hospital so they could manage the data and create superbills for the patients. This group NPI is now necessary for every health care sector, and after the invention of this intervention, the administration could manage and protect the patient’s information. US health department is working to improve the super billing and CMS 1500 form with the help of group NPI. (Parsons, 2017)


US health and human services had analyzed that patient’s information is necessary to be kept confidential. For that purpose, they had introduced National Providers Identifier (NPI) necessary for the health care providers so they could privately share the patient’s information to the respective health care provider and secure the data. For individual or sole proprietors, individual NPI is used that is linked with EIN. Whereas the Group NPI uses for the team or hospitals in which all the health care providers use the same number. Moreover, group NPI helps manage the administration work to improve the efficiency of health care department operations.