Who needs an NPI Number?

What is the National Provider Identifier (NPI)?

The NPI is a 10-digit number that is unique to each health care provider and can be used everywhere in the nation. It contains no “intelligence” about the provider and is granted for life.

A National Provider Identifier, or NPI, is a 10-digit identifying number issued by the Centers for Medicare and Medicaid Services to healthcare providers in the United States. The NPI took the place of all “legacy” provider numbers such as:

UPIN (Unique Physician/Practitioner Number)

Medicaid Provider Number

Medicare Provider Number

Blue Cross and Blue Shield Numbers

Even if your address, taxonomy, or name change, your NPI will remain the same. Even though each NPI is unique, it does not contain personal information about you, such as your state of practice or expertise.

What is the National Provider Identifier (NPI) Requirement?

The federal Department of Health and Human Services has mandated the use of the National Provider Identifier (NPI) as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The Governing Rules for NPI were defined and published by CMS on January 23, 2004. For HIPAA transactions, NPIs replace Provider Numbers assigned by Medicare, Medicaid, local carriers, and other federal agencies.

The Final Rules assigned responsibility for obtaining an NPI number to health plans, health care clearinghouses, and covered health care providers, rather than the states.

Who needs an NPI number?

Who needs an NPI number?

An NPI is necessary for any healthcare provider, clearinghouse, or institution that conducts transactions or uses health records that are subject to HIPAA laws.

This covers organizations and providers who have their claims processed by a medical billing company. An NPI number is required by HIPAA for any individual, business, or healthcare agency that communicates any patient health information in electronic form in connection with a transaction.

A provider’s NPI cannot be modified once it is issued, and it remains with them regardless of their position or where they reside or work.

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