A National Provider Identifier (NPI) number is a unique identifying number assigned to each healthcare provider and organization in the United States.
NPIs were introduced in 1996 as part of the Health Insurance Portability and Accountability Act, with the goal of improving the efficiency of electronic health records (HIPPA).
The Centers for Medicare and Medicaid Services (CMS), as well as all health care plans and clearinghouses, use NPIs to process payment claims, as well as financial and administrative activities.
The NPI (National Provider Identifier) Number is a 10-digit numerical identifier that identifies an individual provider or a healthcare entity. For billing purposes, an NPI number is shared with other providers, employers, health plans, and payers.
The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) required each healthcare provider to use a standard, unique health identifier, according to CMS.gov.
What does an NPI look alike?
The National Provider Identifier (NPI) is 10-position all-numeric identification number assigned by the National Plan and Provider Enumeration System (NPPES) to uniquely identify a health care provider.
For a total of 10 numeric digits, NPI numbers have 9 numeric digits and one numeric check digit.
NPI numbers are compatible with ISO identification card standards for a card issuer identifier. NPI numbers have no embedded intelligence.
Who Needs An NPI Number?
An NPI is necessary for any healthcare provider, clearinghouse, or organization that conducts transactions or uses health records that are subject to HIPPA laws.
This covers organization and providers who have their claims processed by a medical billing company.
An NPI number lookup is required by HIPPA for any individual, corporation, or healthcare agency that communicates any patient health information in electronic form in connection with a transaction.
HIPAA-covered providers and organizations include:
- Ambulance companies
- Chiropractors
- Clinical Social Workers
- Clinical Therapists
- Clinics
- Dentists
- Group Practices
- Health care clearinghouses
- Health care plans
- Home health care agencies (HHA’s)
- Hospitals
- Licensed Therapists
- Medical Equipment suppliers
- Medical Laboratories
- Nurses
- Nursing homes
- Opticians
- Optometrists
- Pharmacies
- Pharmacists
- Physical therapists
- Physicians
- Physician Assistants
- Psychologists
- Residential Treatment Centers