NPI Numbers 101: Everything Healthcare Providers Need To Know

A National Provider Identifier number is an identification marker of ten digits. The number reflects one’s identity as a healthcare provider. The number is used for other identification and administrative purposes within healthcare, including identification of providers, healthcare employers, health plans, and billing. The establishment of this standardized identification process was set in motion by the Health Insurance Portability and Accountability Act of 1996 and was HIPAA-mandated. 

Unique numbers were introduced to offset the disorganized process before their implementation. Previously, numbers were issued without standardization, leading to frequent errors and complications. For instance, the lack of standardization led to providers having multiple numbers, making it impossible for claims to assign the right plans to providers. As a result, one provider’s number could be applied to other providers by health plans. 

With the NPI Final Rule intact, health providers were given one identifier to use, simplifying the process across healthcare administration teams. The simplified method is beneficial today, with electronic records used consistently across practices to gather health information. For more information on your NPI number, here is everything healthcare providers need to know. 

How Do I Know If I Need This Identification Marker? 

The 45 CFR 160.103 lists the definition of a healthcare provider. All people and establishments that meet these terms and those indirectly associated (clearinghouses, suppliers, etc.) require an NPI. 

Two Provider Types Outlined 

• There are two kinds of NPI providers: individuals and organizations.  Individuals who make up Type 1 care providers including, but not limited to: doctors, dentists, and surgeons. 
• Type 2 organizations consist of but are not limited to: healthcare units, hospitals, incorporated providers, and other care facilities. 
• If your position requires you to have an NPI, check the descriptions within 45 CFR 160.103, and look up your NPI number to see if it exists.

How Can I Get An NPI Number? 

The most efficient way to obtain your NPI number is to complete an application with the National Plan and Provider Enumeration System. You can apply online and rely on the credentials you create through the Identity & Access Management System. Your NPI number will correctly identify you as a provider because the number is specific to you and does not change. 

What Happens After Getting Assigned? 

After it’s assigned, your number will always stay the same. A consistent number makes identification purposes easier to manage across boards, no matter if you change locations or jobs. Not only does the standardized process keep things systematic and organized, but it protects against fraud. Remember that your NPI number identifies you as a provider or of an organization but does not take the place of a license or any additional required identification markers.

Apply For Your Number Today 

The NPI number makes identifying providers and organizations effective and efficient for various healthcare administrative purposes. If you are a healthcare provider or associated with a health organization, and have yet to receive your NPI number, get in touch with NPPES and apply today.