National Provider Identifier (NPI): The 10-digit identification number for providers

National Provider Identifier (NPI): The 10-digit identification number

keyboard with stethoscope, keyboard and pen, and the phrase; National Provider Identifier
The National Provider Identifier (NPI) number is a unique 10-digit identification number issued to a healthcare provider or organization by the Centers for Medicare & Medicaid Services (CMS) through its agency called the National Plan and Provider Enumeration System (NPPES). The NPI number is used in billing transactions and is as unique to the provider or organization as any individual’s social security number or fingerprint is to them. Hence, once assigned, that provider or organization will carry that same NPI number until their career or business activity ends (one NPI per provider). In the event of a change, for example, a job change; the individual provider is required by law to update that information within 30 days or be out of compliance. Certain updates can be completed online while some others like changes in social security numbers are completed via a web-available Update form (see “What types of changes would warrant an update?” for clarity)

Content:

person confused about NPI number, standing next to a giant question mark

According to the Centers for Medicare & Medicaid Services, all healthcare providers who are HIPAA-covered entities, whether individuals or organizations, MUST obtain a National Provider Identifier number.  

A HIPAA-covered entity includes:

  • Healthcare provider that conducts certain transactions in electronic form 
  • Health care clearinghouse 
  • Health plans (such as commercial plans, Medicare, and Medicaid):
    • You are considered a covered healthcare provider if you electronically transmit health information by HIPAA standards.

Consequentially, you are included in the list of covered healthcare providers if you electronically transmit or share patient-sensitive information while adhering to the principles of HIPAA. The types of possible electronic transactions are vast and I will not be indulging in those, for now! As an example, consider a practice location that maintains physical charts but sends their patient’s prescriptions electronically to a pharmacy. That organization is considered a covered entity, as is the provider prescribing the medication. 

The terms “electronic form” and “electronically” will continue to show up in NPI discussions. This is largely in part because our medical system has transitioned to the electronic realm of transactions, supported by the meaningful use incentive under the HITECH LAW. Currently, most medical organizations in the U.S engage in some level of patient information exchange.

Types of NPI providers

There are two types of National Provider Identifier provider groups; Type 1 and Type 2 NPI providers. The Type 1 NPI group are health care providers who are individuals (or a sole proprietor/sole proprietorship) who provide services to human patients, that is, “for yourself/by yourself.” Some examples include; dentists, nurses, nurse practitioners, pharmacists, physical therapists, physicians, physician assistants, e.t.c. The Type 2 NPI provider group encompasses health care organizations, such as ambulance companies, clinics, group practices, health maintenance organizations (HMOs), home health agencies (HHAs), hospitals, nursing homes, suppliers of durable medical equipment (DME), e.t.c.

Clarifying some National Provider Identifier items:

NPI renewal

Your NPI is yours for life and will never expire or be recycled and assigned to a different healthcare provider, similar to your social security number. You are however responsible for keeping it updated within 30 days of any change.

What types of changes would warrant an NPI update?

Changes to the date of birth, social security number, deactivation, and reactivation of an NPI. These changes can be completed on a web-available form called the Update form. While online, you can type in your responses, then print, sign, and mail the Update form. You can also print the form in its uncompleted state, then legibly write in your responses. Once completed, you should sign and mail it to the provided address. Do not forget to attach supporting documents based on the reason for the update. It is important to MAIL your NPI Application/Update forms via postage because they will not be processed if you EMAILED or FAXED them to the agency.

On the other hand, changes such as change of business/employer, change of primary practice location and address, phone number, and changes to primary taxonomy (i.e changes to your specialization) can be completed by the provider via accessing their account online and using the “pencil icon” to dit and update your information. Changes to your information may not always take effect right away; it would have to be reviewed by the NPPES team to ensure such a change is permitted. While waiting for the final decision, your status would show “Change Request in Progress.” See the image below (click to enlarge it).

magnifying glass and pencil icon

 What if I changed my name?

When you legally change your name, you are required to notify the social security office and provide supporting documents. Upon approval, your name will be updated in their records and you will receive a new social security card but your number remains the same. Once this step is complete, you can easily log into your NPI online account and update your name using the “pencil” icon to edit your information (see above). Follow the prompts to save and submit changes, after which you would notice a “blue” button next to the phrase “change request in progress.” Check back weekly to ensure your request has been satisfied.

Ways to view your NPI number?

There are two ways to access this information. The first is by logging into your account, while the second is by looking up yourself in the NPI Registry. Be aware that whatever information is displayed is also publicly available to anyone who searches for you. This was made possible by this law requirement (45 CFR Part 162) along with the Freedom of Information Act (FOIA) and eFOIA amendments to the FOIA. Thus, there is no way to “opt-out” or “suppress” that information if your NPI number is still active.

What is the difference between a business address and a mailing address for an NPI application?

When it comes to the business address, CMS is asking for your practice location address or the address under which the business is registered. For certain business individuals, this may also be their residential address because they registered their business under their residential address. The confusion seems to arise from “mailing address” or “correspondence mailing address.” Simply put, CMS does not care to know where you live! They are strictly all about business and where you function as a provider. Hence, a mailing address means your work address where they can reach you if any concerns or questions arose. CMS explicitly stated that; “Do not report your residential address unless it is also your Business Mailing Address” and “Do not report your residential address unless it is also your Business Practice Location.

To drive home additional thoughts, it is important to not fall into the comfort of using your home address to fulfill this requirement. This is because whatever address you use will become publicly available. The aforementioned should be crucial to every provider, especially if your patients suffer from psychological and mental illness, and may have varying thoughts about the services received. Given our current climate of violence, grievance, and disagreements, we as providers should place priority on our safety.

What is the importance of the NPI number to prescribing providers?

Any provider who chooses to obtain licenses from State and Federal drug control agencies must have an NPI number (except veterinarians)  Therefore, your NPI number opens the door to obtaining other professional licenses.

How do I apply for my NPI number?

In the next post, I will be showing you the step-by-step process of applying.

Please feel free to comment, suggest, and/ or ask questions below.

8-Easy steps to completing your NPI application

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