National Provider Identifier

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A National Provider Identifier or NPI is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).

The NPI replaces the unique provider identification number (UPIN) as the required identifier for Medicare services, and will be used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and is slated to begin taking effect in October 2006. ^[1] HIPAA covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans must use only the NPI to identify covered healthcare providers by May 23, 2007. Small health plans have 3 years to comply.

All individual HIPAA covered healthcare providers (physicians, nurses, dentists, chiropractors, physical therapists, etc.) or organizations (hospitals, home health care agencies, nursing homes, residential treatment centers, group practices, laboratories, pharmacies, medical equipment companies, etc.) must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency prepares the transaction. Once assigned, a provider's NPI is permanent and remains with the provider regardless or job or location changes.

Other health industry workers, such as admissions and medical billing personnel, housekeeping staff, and orderlies, who provide support services but not health care, are not required to obtain the NPI.

The NPI was proposed as an 8-position alphanumeric identifier. However, many stakeholders preferred a 10-position numeric identifier with a check digit in the last position to help detect keying errors. The NPI contains no embedded intelligence; that is, it contains no information about the health care provider, such as the type or location of the health care provider.

The NPI must be used in connection with the electronic transactions identified in HIPAA. In addition, the NPI may be used in several other ways:

by health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;
by health care providers to identify other health care providers in health care transactions or on related correspondence;
by health care providers on prescriptions (however, the NPI will not replace requirements for the Drug Enforcement Administration number or State license number);
by health plans in their internal provider files to process transactions and communicate with health care providers;
by health plans to coordinate benefits with other health plans;
by health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;
by electronic patient record systems to identify treating health care providers in patient medical records;
by the Department of Health and Human Services to cross reference health care providers in fraud and abuse files and other program integrity files;
for any other lawful activity requiring individual identification

The NPI number can be obtained online through the National Plan and Provider Enumeration System (NPPES) pages on CMS's website.^[2] Turnaround time for obtaining a number is almost instantaneous, unusual for a medical credentialing operation. As of March 18, 2007, there is no web-based system to search NPI numbers, as there is for DEA numbers and Medicare provider numbers.

A NPI Number may be validated using the Luhn algorithm.