National Provider Identifier (NPI)

Introduction & Background

The Health Insurance Portability and Accountability Act of 1996, (HIPAA) mandated that the Secretary of Health and Human Services, (HHS) adopt a standard unique health identifier for health care providers.

On January 23, 2004, HHS published the Final Rule that adopts the NPI as the standard unique health identifier for health care providers. The effective date of the rule is May 23, 2005. Health care providers may apply for NPIs beginning on the effective date.

The compliance date for health plans, (and all other covered entities) is May 23, 2007, except for small health plans which do not need to comply until May 23, 2008. When NPI is implemented, health plans will use only the NPI to identify health care providers in all standard transactions. Legacy identification numbers, (such as UPIN, Blue Cross or Blue Shield Numbers, CHAMPUS Number, Medicaid Number, etc) will no longer be permitted. Health care providers will no longer have to keep track of multiple numbers to identify themselves in standard transactions with one or more health plans. However, the Taxpayer Identifying Number may need to be reported for tax purposes as required by the implementation specifications.

The NPI is a numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10 th position. It is accommodated in all standard transactions, and contains no embedded information about the health care provider that it identifies. The assigned NPI does not expire.

In certain situations, it is possible for "subparts" of organization health care providers (such as hospitals), to be assigned NPIs. These subparts may need to be assigned NPIs in order to conduct standard transactions on their own behalf or to meet Federal regulatory requirements related to their participation in health plans such as Medicare. The Final Rule requires covered health care providers to determine if they have subparts that may need NPIS and, if so, to obtain NPIs for the subparts. The subpart concept does not pertain to health care providers who are individuals.

Health care providers will be assigned NPIs upon successful completion of an application form. The form can be submitted on paper or over the Internet. Once a health care provider has been assigned an NPI, it must furnish updates to its data within 30 days of any changes.

A single entity, know as the enumerator, and performing under a Centers for Medicare & Medicaid Services, (CMS) contract, will operate the National Provider System, (NPS). The enumerator will receive applications and updates from the health care providers. The enumerator will assist health care providers in completing applications and in furnishing updates, and will be responsible for resolving problems and answering questions.

Information about NPI implementation, including information on how to apply for NPIs, will be made available to the health care industry by CMS closer to the effective date.

For further information on NPI, please check out the following:

» Frequently Asked Questions

» Acceptance Calendar by Health Plan

» Additional Resources & Links

For further information on NPI, please check out the following:

» Frequently Asked Questions

» Acceptance Calendar by Plan

» Additional Resources & Links