what is a NPI number?

Source: Centers for Medicare & Medicaid Services (CMS)

NPI means National Provider Identifier, which is a unique identification number for health care providers.

Health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions specified by HIPAA. The Health Insurance Portability and Accountability Act (HIPAA) has mandated the adoption of standard unique identifiers for health care providers and health plans in order to improve the efficiency and effectiveness of the electronic transmission of health information.

The Centers for Medicare & Medicaid Services (CMS) has developed the national plan and provider enumeration system (NPPES) to assign these unique identifiers. These unique identifiers are known as National Provider Identifier (NPI). The NPI is a 10-digit identifier. The first 9 digits are the identifier and the last digit is a check digit to help detect keying errors. The NPI contains no embedded intelligence, that is, it contains no information about the health care provider such as the type of health care provider or the State where the health care provider is located.

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, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways.

NPIs are given to health care providers that need them to submit claims or conduct other transactions specified by HIPAA. A health care provider is an individual, group, or organization that provides medical or other health care services or supplies. This includes physicians and other practitioners, physician/practitioner groups, institutions such as hospitals, laboratories, and nursing homes, organizations such as health maintenance organizations, and suppliers such as pharmacies and medical supply companies.

A health plan or other payer may reject a pharmacy claim because it does not have the prescriber ID, that is, the prescriber's NPI is required for a pharmacy claim transaction. Pharmacies are expected to make all reasonable efforts to obtain and utilize the appropriate individual NPIs for prescribers.

The Centers for Medicare & Medicaid Services (CMS) has created a NPI registry. Health care providers must apply for an NPI by entering their information on the NPI registry.

Click here in order to search the NPI registry.