Centers for Medicare & Medicaid Services CMS has developed the National Plan and Provider Enumeration System (NPPES) to assign unique identifiers to health care providers.
The National Plan and Provider Enumeration System (NPPES) assigns NPIs, maintains and updates information about health care providers with NPIs, and disseminates the NPI Registry and NPPES Downloadable File.
The NPPES Registry releases all of its data in compliance with the NPPES Data Dissemination Notice. The NPI Registry is completely free to use.
Who Needs An NPI Number?
An NPI is mandatory for any healthcare provider, clearinghouse, or institution that conducts transactions or uses health records that are subject to HIPAA laws. This covers organizations and providers who have their claims processed by a medical billing company.
An NPI number is required by HIPAA for any individual, business, or healthcare agency that transfers any patient health information in electronic form . A provider’s NPI cannot be modified once it is issued, and it remains with them regardless of their position or where they reside or work.
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
How is an NPI number used?
An NPI number is a unique identifier for each provider or entity, and all healthcare plans are required to use it for all administrative and financial transactions. Health plans used to assign their own ID numbers to each health care provider. As a result, depending on which health plan they were submitting claims to, each provider had to use a different ID. The NPI number is used with any electronic transaction identified in HIPAA.
