Who is eligible for an NPI number?
What is an NPI Number?
The NPI (National Provider Identifier) Number is a 10-digit numerical identifier that is used to classify a single provider or a healthcare organization. Other suppliers, employers, health plans, and payers all have access to an NPI number.
The HIPAA required the implementation of a common, specific health identifier for each health care provider, and the NPI satisfies this requirement. In the administrative and financial transactions required by HIPAA, covered health care providers, all health plans, and health care clearinghouses must use NPI numbers..
Who is eligible for an NPI number?
A National Provider Identifier is available to all individuals and organizations that meet the definition of a health care provider as defined by 45 CFR 160.103. (NPI).
You must have an NPI whether you are a HIPAA-covered provider or a health care provider or supplier that bills federally funded programs for services. Before enrolling with Medicare, providers must obtain an NPI Number. All health care providers (physicians, suppliers, hospitals, and others) may get an NPI.
Type 1 NPI providers and Type 2 NPI providers are the two kinds of NPI Number providers. Individuals with a Type 1 NPI include sole proprietors, dentists, doctors, and surgeons.
A provider is eligible for a single NPI. Acute care services, health systems, hospitals, physician associations, assisted living facilities, and incorporated health care providers are examples of Type 2 NPIs.
A provider doesn’t need to be assigned an NPI Number to practice medicine. An NPI is not needed for a health care provider who is not covered by HIPAA, has opted out of Medicare/Medicaid, and/or accepts no third-party payments.
NPI lookup by state
You can look up a provider’s NPI number using the NPI Registry, an online portal that allows users to check for a health care provider’s NPI number.
The Public Search of the National Provider Identifier Registry is a free repository of all active NPI information. NPI specifics such as the provider’s name, specialty, and practice address are available to the public.
