Who must use the NPI and when?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. For covered health care providers, the NPI is a unique identification number. The NPIs in the administrative and financial transactions are implemented under HIPAA and covered health care services, all health plans, and health care clearinghouses must use it for their administrative and financial transactions. It is a 10 digit intelligence-free number which means it does not carry other information about healthcare providers, such as the state in which they live or their medical specialty. Once given to an individual it NPI will not change and will remain with the provider regardless of job or location changes.

Also, covered insurers must share their NPI with other providers, health plans, clearinghouses, and any agency that may need it for billing purposes under the Health Insurance Portability and Accountability Act (HIPAA).

Who must use NPI?

An individual or an organization that fits the definition of a "health care provider under HIPAA," i.e. any provider of medical or other health services and any other individual or entity that receives, bills, or is paid for health care in the course of business is eligible to obtain NPI. Health care providers as defined in CFR 160.103 are classified as below:-

1. Ambulance companies

2. Chiropractors

3. Clinical Social Workers

4. Clinical Therapists

5. Clinics

6. Dentists

7. Group Practices

8. Health care clearinghouses

9. Health care plans

10. Home health care agencies

11. Hospitals

12. Licensed Therapists

13. Medical Equipment suppliers

14. Medical Laboratories

15. Nurses

16. Nursing homes

17. Opticians

18. Optometrists

19. Pharmacies

20. Pharmacists

21. Physical therapists

22. Physicians

23. Physician Assistants

24. Psychologists

25. Residential Treatment Centers

How do I verify a doctor's NPI number

Who is not eligible to receive an NPI?

Any individual or organization that does not meet the definition of health care provider” found at 45 CFR 160.103 is not eligible to apply for an NPI.

When to use NPI? Having an NPI simplifies the exchange of healthcare information. NPI is used in all HIPAA standardtransactions.

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