NPI: What You Need to Know

What is an NPI number?

An NPI number, known as a National Provider Identifier, is a unique 10-digit unique identification number issued to each healthcare provider or organization in the United States. It is used by healthcare professionals to identify themselves or other providers, and patients/providers on Medicare and Medicaid claims to process payment claims and transactions of medical service. These numbers help improve the efficiency of electronic health records, and are required as part of the Health Insurance Portability and Accountability Act (HIPAA) introduced in 1996.

Who must get an NPI number?

An NPI number is assigned to all licensed healthcare providers,healthcare organizations, and healthcare clearinghouses, that transmit and conduct any patient health information in electronic form. Once a provider receives an NPI number, it cannot be changed regardless of the current position and location in which they live.

Common Providers and organizations include:

Physicians
Nurse practitioners
Dentists
Pharmacists
Chiropractors
Clinics

Dentists
Health care clearinghouses
Health care plans
Home health care agencies (HHA’s)
Hospitals
Licensed Therapists

Medical Laboratories
Nurses
Pharmacies
Pharmacists
Psychologists
Residential Treatment Centers

How to apply for an NPI number?

There are currently 3 ways to apply for an NPI number:

Online- Through the National Plan and Provider Enumeration System (NPPES) website located at nppes.cms.hhs.gov (easiest way to obtain an NPI number)
Paper Application- form can be accessed at CMS website and mailed to customerservice@npienumerator.com
Through the Electronic File Interchange Organization (EFIO)- gives permission to submit applications. More details can be found on the CMS website.

What are the benefits of an NPI number?

Benefits of an NPI number include:

Provides instant and simple electronic connections of HIPAA transactions
Increases job efficiency of medical providers and organizations
Ensure efficient directions of benefit transactions in future

What an NPI number Doesn’t Do?

Automatic enrollment in any health plan
Guarantee any type of credentials or license
Guarantee health plan payment
Compulsory action to conduct a HIPAA transaction

How do I find my NPI number?

You can use our NPI lookup tool that searches our full database at npilookup.evalyticslabs.com. Our database is updated regularly and combines NPI numbers and other datasets to present provider information in an easy-to-use format.