NPI numbers were introduced as part of the Health Insurance Portability and Accountability Act in 1996 and by 2007 became the only way to identify healthcare providers for American health insurers.
But what is an NPI number?
An NPI number is a unique 10-digit code that’s used to identify medical professionals and healthcare providers. It’s used by patients and health insurance providers on Medicare and Medicaid claims forms to identify those who provided the medical service.
This article covers all you need to know about NPI numbers, including answering questions such as how do I find my NPI number, and what is the NPI number application cost.
The purpose of an NPI number
An NPI number is assigned to a medical professional or healthcare provider upon registration. The number remains with the individual or service regardless of whether they change specialties or location. This allows insurance providers to always identify the individual.
The NPI number is used on HIPAA transactions related to Medicare and Medicaid, such as claims forms. But it can also be used for the following purposes:
- Attached to patient’s prescriptions by healthcare providers
- For healthcare providers to identify themselves on correspondence related to HIPAA
- On patient medical records to identify previous healthcare providers
- On transactions and communications between health plans and healthcare providers
- Any other healthcare related activity that requires unique identification
In short, an NPI number is a vital form of identification for healthcare providers and is the expected standard nationwide for all those taking part in Medicare and Medicaid services.
Who gets an NPI number?
Anyone who provides Medicare or Medicaid related services needs to have their own NPI number. However, it’s not just for individual practitioners but for physical entities too. Individuals who need an NPI number include:
- Nurse practitioners
- Physical therapists
- Occupational therapists
The list goes on, but these are some of the most notable examples. In short, anyone who provides a medical service that’s covered by HIPAA legislation needs one.
Some of the organizations that require an NPI number include:
- Nursing homes
- Residential treatment facilities
- Medical equipment providers
If you’re unsure what one looks like, here is an NPI number example: 1354275899.
NPI numbers are split into 2 categories: type 1 (individuals) and type 2 (organizations). An individual applies for an NPI number using their Social Security Number rather than their Employer Identification Number.
An individual medical practitioner (such as a physician) only needs one NPI number, which is assigned for the duration of their career and never expires. This is unaffected by the following situations:
- The individual has offices based in several locations
- Whether they employ anyone in their service
- Whether or not you have an EIN
Organizations fit under type 2. Type 2 NPI numbers are applicable whether the organization has one employee or hundreds. The difference is that the person is registered as an organization rather than an individual practitioner.
Also, an organization can arrange for any subparts within it to have their own NPI numbers. This is relevant if the subpart conducts their own HIPAA related electronic transactions, such as a physio department inside a hospital. Having different NPI numbers makes transactions easier to process.
Do you need a medical license for an NPI number?
If you are a healthcare provider without a medical license, you can still apply for an NPI number. You just have to apply as a student using the correct code, which is 390200000X. You can find more information on the process on the CMS website.
This is also the correct application code for those who need an NPI number as part of their training but aren’t yet fully qualified. For example, this might include those studying on a medical degree or for certification to practice.
Who can’t have an NPI number?
While the definition of who must have an NPI number seems quite wide reaching, there are people and organizations that cannot have an NPI number. This is any not covered by the definition of a healthcare provider stated in the HIPAA section 45 CFR 160.103.
- Billing services
- Health plans
- Healthcare clearinghouses
- Non-emergency transportation services
- And more
If you’re unsure whether your organization wouldn’t be covered by the rules, check the official guidelines for more information.
How do I find my NPI number?
The easiest way to find an NPI number, whether you’re a healthcare provider or patient, is to use an NPI registry. These can help you answer the question, how do I find my NPI number, quickly and easily.
To use an NPI registry, you need some starting information. This can either be the name or location of the healthcare provider. But the more information you can enter, the better.
If you’re searching for your own NPI number, this shouldn’t be too difficult. If you’re a patient you must be careful that you pick the correct result.
An NPI registry will bring back all healthcare providers under the name or location you submit. But it’ll also offer new details, such as their practice address, contact information and specialty. This should help you to narrow down your search for the right provider.
Alternatively, a healthcare provider will attach their NPI number to their correspondence (as mentioned above). While this isn’t strictly necessary for patient-facing documents, many will do this just for convenience. Having the information readily available makes it much easier for people to fill out their medical claim forms.
How to apply for an NPI
There are three ways to apply for an NPI number, but the NPI number application cost remains the same for all. The options are:
You can apply for an NPI number online on the National Plan and Provider Enumeration System (NPPES) website. You must first create a username and password on the Identity and Access Management system that you can use to log in to the application process. This is arguably the easiest way to obtain an NPI number.
2. Paper application
Alternatively, you can fill in a paper form, which you must sign and then send off to the address on the form. You can get the form off the CMS website or by emailing [email protected]
3. Through the EFIO
Finally, you can give the Electronic File Interchange Organization permission to submit your application through the bulk enumeration process. You can find more information on this process on the CMS website.
The application process is completely free for an NPI number, making it quick and easy to apply. The online application takes approximately 5 minutes and you’ll have your NPI number shortly after applying. While the other options take a bit longer, they’re still free.
NPI numbers might seem confusing initially, but the system is fairly straightforward. A healthcare provider needs one if they deal with HIPAA electronic transactions, and patients or insurance providers must attach NPI numbers to their claims forms.
Using an NPI lookup to find a practitioner’s NPI number is a quick and easy way of obtaining the information. From a patient’s perspective, it saves keeping the information on hand for whenever you have to submit a form.