What Are NPI Numbers and Why Are They Important?

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A national provider identifier, or NPI number, is a unique 10-digit identification number for covered health care providers in the U.S.

Part of HIPAA, or the Health Insurance Portability and Accountability Act of 1996, included Administrative Simplification provisions. In these provisions was a mandate for standard unique identifiers for all health care providers and health plans that are covered by HIPAA. CMS developed the system to assign these unique identifiers.

The National Plan and Provider Enumeration System, part of CMS, provides NPI numbers through its website. CMS also has a search service for all NPI records in its free directory.

There are 2 types of NPI numbers: Type 1 is for individual service providers, for example physicians, physician assistants, dentists, physical therapists, chiropractors and nurse practitioners.

Type 2 is for a business or organization that provides services or health care supplies such as hospitals, nursing homes, group practices, laboratories, pharmacies and home health care agencies.

Once assigned, the provider's NPI remains with the provider even through location or job changes.

How Are NPI Numbers Used?

NPI numbers are necessary in order to receive reimbursement from insurance companies and to prescribe medications, as well as to refer patients to other health care practitioners that participate in health plans.

NPI numbers are also used by health care providers for:

  • Identifying themselves in HIPAA health care transactions.

  • Identifying other health care providers in transactions or correspondence.

  • Prescribing medication.

Health plans use NPI numbers to communicate with providers, to process transactions and to coordinate benefits as needed with other plans.

Electronic patient recordkeeping systems use NPI numbers to identify those treating providers in patient records.

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If you require medical credentialing and payer enrollment needs for your practice or medical facility, please contact 1st Assistant. Our experienced and dedicated specialists will provide all credentialing and enrollment services quickly and will monitor your account for ongoing updates and re-attestations. Heidi Henderson, our company owner and President, is eager to meet you and discuss your payer enrollment needs. Please call us at 512.201.2668 or contact us via the website.