What is an NPI number?

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 health industry.

The NPI number is the official identifier for Medicaid service providers as well as other private health services. The NPI number officially replaced the UPIN (unique provider identification number), which was used in the past. Health care providers must apply for an NPI number through an application process on the CMS website. Health practitioners need to have this number in order to receive reimbursement from insurance companies and to prescribe medicines. Plus, in order to refer patients to other practitioners who are in the insurance system, an NPI number is necessary.

The NPI number system was established by Congress in the Health Insurance Portability and Accountability Act (HIPAA) in 1996. The numbers began to be issued in 2006. Social Security number, date of birth, city and state, license number and country of birth are required information to receive the NPI number. Once an NPI number is issued, it is permanent regardless of circumstances such as job or location change. 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, physicians, physician assistants, physical therapists, psychiatrists, counselors, dentists, chiropractors, pediatricians, social workers and so forth. These professions can be under an organization or they can be a private, individual service. As for organizations, hospitals, nursing homes, treatment residences, rehabilitation centers, internal medicine centers, pharmacies and medical laboratories also need an NPI number. All HIPAA business and services require the NPI.

What Else is It Used For?

There are some other ways in which an NPI can be used–for medical activities requiring identification, identifying health care providers on patient records, for health plans to work with other health plans, for health care practitioners to identify other health care practitioners and organizations and for the Department of Health to use when investigating fraud.

NPI Registry

There is a national registry for the NPI number which can be accessed online. It was made available on Sept. 4, 2007. It can be utilized to find the NPI of another provider, if necessary.