What is a National Provider Identifier (NPI) Number?
Terminology in the medical field can be complicated, often leaving those new to the profession — and even experienced practitioners — with questions about their meaning. Healthcare facilities must adhere to a long list of requirements to remain in compliance. As you look into federal regulations for your residence or facility, you may be wondering: What is an NPI number?
A National Provider Identifier (NPI) number is a federally-issued 10-digit identifier unique to healthcare providers, health plans, and healthcare clearinghouses. These numbers are required for medical organizations in the U.S. as part of the Administrative Simplification Standards of the Health Insurance Portability and Accountability Act (HIPAA) of 1996.
The purpose of NPI numbers is to standardize identification methods across the country. Use of these numbers promotes patient privacy and improves efficiency in administrative tasks.
What Is an NPI Number Used For?
If you’ve ever wondered what an NPI number is used for, you’re not alone. Simply put, NPI numbers are used to identify healthcare providers in their respective financial and administrative transactions (these are distinct from CPT codes, which identify healthcare treatments and services). Basic information about the provider can be effectively shared using this number, without violating the patient’s privacy.
For example, a physician may send information through electronic methods to an insurance company for billing purposes. In that correspondance, they would include their NPI number and those of related healthcare providers.
When the insurance company receives the communication, they can check the provider’s NPI number in a database to verify their identity. This streamlines the billing process and ensures that the information shared in patient-focused correspondences is standardized.
Who Needs an NPI Number?
Any individual or organization classified as a healthcare provider in the U.S. needs an NPI number to comply with federal regulations. There are two types of providers in regard to NPI categorization:
- Type 1 – Individuals: These NPI numbers are assigned to individual healthcare providers within a group practice, or to sole proprietors. This includes physicians, surgeons, dentists, nurses, psychologists, and other roles, even if they work within a larger medical practice.
- Type 2 – Organizations: This type of NPI number is assigned to medical groups who employ healthcare professionals. If a provider offers different types of care within a larger system, each component part of the system may be eligible for its own unique NPI number.
How Many NPI Numbers Can a Provider Have?
While individual providers are only assigned one number, a healthcare group may have multiple numbers for the different parts of their organization. For example, a health system might include a laboratory, pharmacy, and acute care facility, which could each be assigned an NPI number under Type 2 classification.
Additionally, a physician working in the acute care facility would have their own individual NPI number under Type 1. If the physician changes locations to work for a new healthcare system, they would retain their individual NPI number.
Do Nurses Have NPI Numbers?
What is an NPI number’s relevance to nurses? While not all nurses need an NPI number, all advanced practice registered nurses that bill health insurers through electronic methods do. This typically includes Certified Nurse Practitioners (CNP), Certified Registered Nurse anesthetists (CRNA), and Certified Nurse-Midwives (CNM). A nursing professional who isn’t responsible for these types of tasks is not required to apply for their own NPI number.
Why Are NPI Numbers Beneficial?
We know that NPI numbers are required for federal compliance, but what is an NPI number’s benefit for healthcare providers? Before the adoption of NPI numbers, healthcare providers often had multiple identification numbers depending on the health plan they were working with, which made billing and administrative tasks much more complex.
NPI numbers provide each healthcare provider in the U.S. with a unique identifier, which is connected to a national database. This streamlines the process of completing medical transactions because providers can use the same number in all of their correspondence. It also protects patient confidentiality because the NPI number only transmits basic identifying information about the provider, not their location or specialty.
Wondering How to Get an NPI Number?
If you need an NPI number, there are several application methods to choose from. The most efficient way is to complete an online NPI application through the National Plan & Provider Enumeration System (NPPES) website. From the “Related Links” section, you can select the “Apply Now” link and enter the relevant information.
NPPES also accepts applications by mail, though it will be more difficult to track the progress of your application with this method. Or, if you need NPI numbers for a large group of providers at once, the Electronic File Interchange (EFI) enables an outside organization to submit the application materials for you, relieving the administrative burden.
Once you receive your number, it will be entered into a national registry managed by NPPES where you can search all active records with the NPI number lookup. This registry publishes information associated with the NPI number that is relevant for public knowledge.
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