National Provider Identifier

Acronym: NPI

A National Provider Identifier is a unique identification number for covered health care providers, created to improve the efficiency and effectiveness of electronic transmission of health information. Covered health care providers and all health plans and health care clearinghouses must use NPIs in their administrative and financial transactions. The NPI is a unique 10-digit “intelligence-free” identification number (“Intelligence free” means that the numbers do not carry information about health care providers, such as the state in which they practice or their provider type or specialization) issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). The NPI has replaced the unique provider identification number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The Administrative Simplification provisions of HIPAA required the adoption of a standard, unique health identifier for each health care provider. The NPI Final Rule, published on January 23, 2004, established the NPI as this standard. Providers were required to begin their assigned NPIs beginning in 2008. The regulation recognizes that a “health care provider” may be an individual person (such as a pharmacist) or an organization (such as a pharmacy). Individual health care providers such as pharmacists, physicians, dentists, nurses, chiropractors, and therapists. Individual Health care providers will receive a Type 1 NPI. Health care provider organizations include: pharmacies, hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, health maintenance organizations, durable medical equipment suppliers, and health care, prosthetics, and orthotics suppliers. Provider organizations will receive a Type 2 NPI. Only health care provider may obtain an NPI. An entity that does not meet the definition of a health care provider as defined in 45 CFR 160.103 may not apply for an NPI. Such entities include billing services, value-added networks, repricers, health plans, health care clearinghouses, nonemergency transportation services, and others. For more information, please see, [https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/NPI-What-You-Need-To-Know.pdf](https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/NPI-What-You-Need-To-Know.pdf) There are two categories of health care providers for NPI enumeration purposes: Entity Type 1 (Individual) and Entity Type 2 (Organization). Please see below for the distinctions between Type 1 and Type 2 NPIs.