What is an NPI?

What is an NPI?

What is an NPI?

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard.

It’s comprised of a unique, 10-digit standardized identification number that never expires or changes throughout a covered healthcare provider’s career. An NPI is different from a state license in that physicians must also maintain a state license in order to legally practice.

This means the ID numbers don’t carry other information about healthcare providers, such as their state of residence or medical specialty. The NPI is used instead of legacy provider identifiers in the HIPAA standards transactions.

Do I Need an NPI?

The NPI is created to quickly and effectively send health information electronically. Covered healthcare providers and all health plans and healthcare clearinghouses use NPIs in the administrative and financial transactions adopted under HIPAA.

In the U.S., healthcare providers are generally required to have n NPI number to bill for services. However, there are some exceptions and specific circumstances in which a provider may be able to practice without an NPI number:

Does an LLC Need an NPI Number?

Not every LLC is required to obtain an NPI number. Providers who have formed a single-member LLC are only eligible for a Type 1 NPI. Providers classified as a partnership or corporation LLC are required to obtain both a Type 1 and Type 2 NPI. Below are descriptions of the two types of API numbers.

NPI Type 1:  This includes providers who are individuals, including physicians and all sole proprietors. The number of different office locations, other employees, and if those employees have an EIN does not change eligibility for a Type 1 NPI. All healthcare providers should obtain an individual Type 1 NPI at the start of their career, as it acts similarly to a social security number.

NPI Type 2: Healthcare providers who are organizations, including physician groups, hospitals, nursing homes, and the corporation formed when an individual incorporates him/herself require a Type 2 NPI. This allows the entire group to become credentialed with an insurance payer, rather than having to undergo the process for each individual provider. Type 2 NPIs indicate that the reimbursement should be made to the organization, rather than to the individual provider. 

Note: If you’re an individual healthcare provider who’s incorporated, you may need to obtain an NPI for yourself (Type 1) and an NPI for your corporation or LLC (Type 2).

How Do I Get One?

Applying for your NPI number takes less than 30 minutes to complete and is free. You can apply online, by mail, or through a designated CMS contractor. The online application is recommended because it’s generally quicker and easier to track the status. To apply, visit the  National Plan and Provider Enumeration System (NPPES) website. After your application is accepted, you’ll receive your NPI via email.

If you already have an NPI and are interested in finding that next great healthcare career position, reach out to Annashae. Simply visit our website, complete our online application – or call to speak with one of our recruiters. Our experienced team is here to help!

Contact Annashae Today to Learn More

At Annashae we’re dedicated to the placement of highly-skilled clinical practitioners in short and long-term positions. As a nationwide medical staffing and consulting firm, we provide a range of services that enable our candidates to quickly find the career opportunity that fits their needs. For information on how you can further your clinical career, contact us today.