NPI: 5 Frequently Asked Questions
1. What is the NPI and how is it used?
The NPI is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. It is a unique identification number for covered health care providers. Covered health care providers and all health plans and health care clearinghouses must use the NPI in the administrative and financial transactions adopted under HIPAA. This means all individual health care providers, health care groups and health care facilities must apply for an NPI to use on all of their transactions with health care payers.
2. How do I apply for an NPI?
There are three ways to apply:
- Online at the NPPES website.
- On the paper application, Form CMS-10114. You can also request the form from the NPI Enumerator by calling (800) 465-3203, by sending an email to customerservice@npienumerator.com, or by sending a letter to NPI Enumerator, P.O. Box 6059, Fargo, ND 58108-6059.
- Through Electronic File Interchange (EFI). If an EFI Organization (EFIO) asks for permission, you may agree to let it submit your application data on your behalf through a bulk enumeration process.
3. What is the difference between an NPI and other provider numbers?
Tax ID or EIN
The Tax ID or EIN is the number the IRS issues to a business for tax purposes. Multiple NPIs can be linked to one Tax ID. For example, a medical practice has 3 providers. Each provider and the practice entity have an NPI, for a total of 4, but the IRS issues only one Tax ID.
UPIN
The UPIN (Unique Physician Identification Number) was a six-character alphanumeric identifier that Medicare used to identify doctors in the United States before the NPI. UPINs were discontinued in June 2007, so they have no use in any health care transaction today.
PIN or PTAN
A PIN (Provider Identification Number) is a unique number that a specific payer, such as Medicaid or Blue Cross Blue Shield, issues to identify a health care provider, group or facility. PINs are becoming obsolete, and in many cases the NPI has replaced them on all health care transactions.
A PTAN (Provider Transaction Access Number) is an identification number that only Medicare uses. The individual and the group each receive a PTAN when they apply to a Medicare contractor. Only the NPI goes on claims, but the PTAN is directly linked to the provider’s or supplier’s NPI. You need both the PTAN and the NPI when you contact the Medicare contractor about claims, enrollment and similar issues. See PTAN number in medical billing for more.
4. Where can I look up NPI numbers?
You can search the complete NPI Registry. It lets you search for both individual and organizational providers. You can search by name, address, or NPI number if you already know it. The registry is public, so anyone can search for NPI numbers. NPIs are not private or confidential.
5. What is the difference between a group NPI and an individual NPI?
When an individual health care provider is not a sole practitioner, the individual NPI must be linked to the group NPI along with the other providers in the practice. When services are rendered, the payer pays the group, not the individual. Specific fields on the HCFA-1500 form show this. Under the 5010 standard, field 24J contains the NPI of the individual rendering provider, and field 33 contains the NPI of the group billing entity.
More information
For more information about the NPI, see the National Provider Identifier Standard (NPI) pages on the CMS website. You can also read the Medicare Learning Network (MLN) publication “The National Provider Identifier (NPI): What You Need to Know” and Chapter 10 of the Medicare Program Integrity Manual (Publication 100-08), which is in the CMS Internet-Only Manuals.
What has changed since this was written
- The HCFA-1500 is now the CMS-1500 (02/12). The rendering provider NPI still goes in box 24J, and the billing provider NPI goes in box 33a. See the CMS-1500 form box by box and rendering provider vs billing provider.
- The NPPES and NPI Registry addresses changed. The old page addresses in the PDF no longer work. Use nppes.cms.hhs.gov to apply and npiregistry.cms.hhs.gov to look up a number.
- Online NPPES applications need a CMS login. You now sign in to NPPES with an account from the CMS Identity & Access Management System (I&A) before you can apply or update an NPI online. See NPI numbers in medical billing for how Type 1 and Type 2 NPIs are used on claims today.