National Provider Identifier (NPI)

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

  • NPI Final Rule
  • NPI Registry - The NPI Registry enables you to search for a provider's NPPES information. All information produced by the NPI Registry is provided in accordance with the NPPES Data Dissemination Notice. Information in the NPI Registry is updated daily. You may run simple queries to retrieve this read-only data. For example, users may search for a provider by the NPI or Legal Business Name. There is no charge to use the NPI Registry.
  • Apply Now - National Plan and Provider Enumeration System (NPPES Website)
    • For organizations, your name in NPPES should reflect your legal business name as reported with the IRS.
  • CMS NPI Website

Medicare contractors cannot instruct providers and suppliers to contact the NPI Enumerator for information regarding NPI policy, NPI eligibility, NPI subpart questions, NPI data dissemination, Medicare's implementation of the NPI, or the electronic file interchange process.

The NPI Enumerator can only respond to operational concerns not policy questions.

If you have a name change, be sure to update this name change with the NPI Enumerator before you submit the change to Medicare.

NPI Tips

  • While not required, claims processing is most efficient when providers set up a one-to-one NPI/CCN match. We recommend that providers avoid getting only one NPI that would be associated to more than one CCN
  • Providers need to make sure they are checking their 1099s as a tax-id edit has been implemented with NPI.
  • It is important for providers to enter their CCN in the "other identifiers" field in NPPES. If the CCN is not entered correctly, Medicare may have problems mapping your NPI to the correct CCN for billing purposes.
  • When listing their CCN in the other identifiers field as stated above, the provider must label their CCN "Medicare OSCAR/Certification."
  • When a provider submits an 855A to enrollment, all appropriate NPI's must be provided. If necessary, submit multiple section 4s to include all locations and NPIs associated to those locations.
  • Providers must update enrollment when they are making changes to their NPI.  If the provider only updates NPPES this may cause claims processing issues.
  • If a provider is terming their association with Medicare, providers must keep their NPI active until all appropriate claims have been billed. Many providers have deactivated their NPI too early and although the CCN is retroactive the NPI is not.
  • The Legal Business Name that Noridian has on file must reflect the Legal Business Name submitted to NPPES.

 

Last Updated Jun 15, 2018