NPI stands for The National Provider Identifier. It is the Administrative Simplification Standard of the Health Insurance Portability and Transparency Act (HIPAA). National Provider Identifier is a unique identification number for covered health care providers. Under HIPAA guidelines it is necessary for all covered health care providers and all health plans and health care organizations to use NPIs in administrative and financial transactions. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

National Provider Identifier is an intelligence free numeric identifier and it does not carry any other information about healthcare providers such as their place of residency or what their medical specialty. According to HIPAA it is mandatory for covered entities to share their National Provider Identifier with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

To know who exactly is eligible for National Provider identifier number (NPI) is matter of research.

Under 45 CFR 160.103, all individuals and organizations that meet the definition health care provider can easily obtain NPI. Also, an individual or any health care provider/supplier that provide HIPAA covering and bills Medicare will also need NPI.

Who Needs an NPI Number?

Any healthcare provider, healthcare clearing house or healthcare agency that performs transactions or uses medical records that fall within the scope of the HIPPA Regulations is needed to obtain National Provider Identifier. This involves agencies and providers who use health billing firms to manage their claims. HIPPA requires that National Provider Identifier be given to any person, business or health organization that transmits any patient medical information in electronic form in connection with a transaction. 

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
Categories: NPI

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