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An NPI (National Provider Identifier) is an identification number given to health care providers by the CMS (Centers for Medicare and Medicaid Services). It is a 10-digit number used for a variety of reasons in the healthcare industry.

The NPI number is the official identifier for providers of Medicaid services, as well as other private health services. The NPI number officially replaces the UPIN ( Unique Provider Identification Number ) , which was used in the past . Healthcare providers must apply for an NPI number through an application process on the website. Health professionals need to have this number in order to receive reimbursement from insurance companies and prescribe medications. Also, in order to refer patients to other professionals who are in the insurance system, an NPI number is required.

More NPI Information

The NPI numbering system was established by Congress in the Health Insurance Portability and Accountability Act ( HIPAA ) of 1996 issues began airing in 2006. Social Security number, date of birth, city and state, license number, and country of birth information is required to receive the NPI number. Once an NPI number is issued, it is permanent, regardless of circumstances, such as work or change of location. If a health care service does not bill insurance companies, it is still mandatory that they have an NPI number.

Who needs NPI?

These are the specific health care professions that need an NPI number- nurses, doctors, physician assistants, physical therapists, psychiatrists, counselors, dentists, chiropractors, pediatricians, social workers, etc. These professions can be under an organization or they can be a particular service. As for organizations, hospitals, nursing homes, treatment homes, rehabilitation centers, internal medicine centers, pharmacies and medical laboratories also need an it. All HIPAA businesses and services require the NPI

What else do you use

There are a few other ways an NPI can be used – . ? For medical activities that require identification, the identification of health care providers in patient records, for health plans to work with other health plans, for health professionals to identify other professionals and organizations health care and to the Department of Health for use in investigating fraud.

NPI registration

There is a national registry for it that can be accessed online. It was made available on September 4, 2007. It can be used to find another provider’s NPI, if needed.

When the number is used

Your provider must submit it each time they conduct and report a HIPAA transaction. These events include the examination and treatment of patients; submitting and verifying claims for insurance benefits, patient referrals, and precertification or preapproval of services.

Mandatory users

In addition to doctors, dentists, pharmacists, nurses, chiropractors, physical therapists, nursing homes, ambulance companies, and medical device providers are among the providers that are required to carry an it. Those who provide services, such as non-emergency ambulance transportation, housekeeping, and installation of railings or ramps to accommodate people with disabilities, are not considered health care providers and do not receive an NPI number. .

Doctor or number lookup

The National Plan and Provider Enumeration System maintains a database for you to find the provider’s NPI number or provider identity. The NPI record will give you, in addition to the NPI, the provider’s address, type of service or general area of practice, and insurers accepted by the provider.




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