National Provider Identifier – AAFP

What is the National Provider Identifier?

The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims.

NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities use NPIs in standard transactions. You are a covered entity if you conduct any electronic transaction with federal health programs. Your individual NPI is yours even if your employer files the application for it. The NPI does not change when you change practices or work in different settings. You will have only one individual NPI. It will be used by all health plans who are covered entities, eliminating what are likely many provider numbers assigned by Medicare, Medicaid, and private payers at present.

Will my NPI information be available to others?

CMS has created an online NPI registry(nppes.cms.hhs.gov) where a physician, other health care provider, or organization can access NPI information. This is part of the same National Plan and Provider Enumeration System (NPPES) web site on which NPI registry is completed. Only the health care provider data elements that are disclosable under the Freedom of Information Act (FOIA) are released.

Information That Will Not Be Disclosed

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Social Security Numbers (SSNs), Internal Revenue Service Individual Taxpayer Identification Numbers (IRS ITINs) and dates of birth (DOB) are not disclosable under FOIA and, therefore, will not be released to the public.

More Information on NPI Dissemination

The CMS NPI Dissemination(www.cms.hhs.gov) has more information regarding the disclosure of NPI information.

Do I apply for an NPI as an individual or group/organization?

Sole Proprietorships

If you practice as a sole proprietorship, you must apply as a type I (individual). You will have to submit your social security number rather than your employer identification number (even if you have one).

Incorporated Practices

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Eligible organizations, including S corporations, may apply for an NPI as an entity Type II (organization). Eligible individuals working within an organization, including an S corporation, may also apply for an NPI as an entity Type I (individual). An S corporation representing only one practitioner is still eligible for a Type II NPI. From an NPI perspective, an S corporation is no different than a limited liability corporation or any other type of corporation.

How do I apply for my NPI?

You can apply for an NPI in one of three ways:

1. Apply online(nppes.cms.hhs.gov).
2. Mail in a written application.
3. Through an electronic file interchange provided by a large organization.

Online and Paper Applications

The fastest and easiest way for most physicians will be completing the online application form. Complete the application online. You will need:

• Legacy (current) provider identification numbers
• UPIN number
• Taxonomy codes
• License numbers
• Mailing address and practice address(es)
• Phone number and the name of the person who will serve as a contact should the enumerator need further information.

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If you have someone other than yourself complete the application, they will also need to know in what country and state you were born, your date of birth, and your social security or individual taxpayer identification number. If you wish to complete a paper application/update form (CMS-10114), this must be obtained by contacting the NPI Enumerator. After receiving the form, mail applicaton completed and signed to the NPI Enumerator located in Fargo, North Dakota, whereby staff at the NPI Enumerator will enter the application data into the enumeration system. The form will be available only upon request through the NPI Enumerator. Health care providers who wish to obtain a copy of this form must contact the NPI Enumerator in any of these ways:

• Phone: (800)465-3203 or TTY (800)692-2326.
• Email: customerservice@npienumerator.com.
• Mail: NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059

Electronic File Interchange (EFI) Offers Bulk Enumeration for Large Organizations

Electronic File Interchange (EFI), also referred to as bulk enumeration, is a process by which physician and other health care providers (hereinafter simply referred to as provider) or group of providers can have a particular organization (the EFIO) apply for NPI on their behalf. In other words, rather than a provider or group of providers submitting a paper or web NPI application, the EFIO obtains an NPI for him/her/them. What makes EFI so unique is that one file can contain hundreds or thousands of providers’ applications. By submitting these applications both simultaneously and electronically, the administrative and financial burdens for both the provider community and the U.S. Department of Health and Human Services (HHS) are greatly reduced. These benefits are enhanced because EFI can also be used to change or update a provider’s existing NPI information. See the CMS Electronic File Interchange Summary(www.cms.hhs.gov) for more information on the EFI process.

What is my taxonomy number?

Physicians may report primary and secondary taxonomy codes in the NPI application. For instance, a family medicine physician specializing in adolescent medicine might report a primary code for family medicine, 207Q00000X, and a secondary code for adolescent medicine, 207QA0000X.