An NPI (National Provider Identifier) is an identification number that is given to health care providers by the CMS (Centers for Medicare & Medicaid Services). It is a 10-digit number that is used for a variety of reasons in the healthcare industry.
The NPI number is the official identifier for Medicaid service providers, as well as other private health services. The NPI number officially replaces the UPIN (Provider Unique Identification Number), which was used in the past. Healthcare providers must request an NPI number through an application process on the website. Health professionals must have this number in order to receive reimbursement from insurance companies and prescribe medications. Also, in order to refer patients to other professionals who are in the insurance system, an NPI number is required.
The NPI numbering system was established by Congress on Portability and Accountability (HIPAA) in 1996. Numbers began to be issued in 2006. Social Security number, date of birth, city and state, license number, and country of birth Information is required to receive the NPI number. Once an NPI number is issued, it is permanent, regardless of circumstances such as change of job or location. If a medical service does not bill insurance companies, it is still mandatory that they have an NPI number.
These are the specific health care professions that need an NPI number – nurses, physicians, physician assistants, physical therapists, psychiatrists, counselors, dentists, chiropractors, pediatricians, social workers, etc. These professions can be under an organization or they can be a private service. As for organizations, hospitals, nursing homes, treatment residences, rehabilitation centers, internal medicine centers, pharmacies and medical laboratories also need an NPI number. All HIPAA businesses and services require the NPI.
There are other ways that an NPI can be used – for medical activities that require identification, identifying health care providers in patient records, health plans to work with other health plans, professionals by health care providers to identify other healthcare professionals and organizations and by the Department of Health to use in the fraud investigation.
There is a national registry for the NPI number that can be accessed online. It was made available on September 4, 2007. It can be used to find another provider’s NPI, if necessary.