A national provider identification (NPI) is a unique 10-digit number used to identify healthcare providers for insurance purposes. If you offer medical services in the United States and bill insurance, you and/or your practice likely need an NPI number.
NPI Number System Introduced
The NPI number system was introduced around 2004 as a means of improving efficiency within the healthcare system. Specifically, it primarily improves efficiency with regard to insurance claims.
As a Department of Health and Human Services report from 2004 details:
“The use of the NPI will improve the Medicare and Medicaid programs, and other Federal health programs and private health programs, and the effectiveness and efficiency of the healthcare industry in general, by simplifying the administration of the healthcare system and enabling the efficient electric transmission of certain health information.”
The Purpose of NPI Numbers
The use of NPI numbers is limited to the healthcare industry, and specifically insurance matters within the industry. The number doesn’t replace a social security number, tax identification number, DEA registration number or state license number. These are all still used for their respective purposes.
Since NPI numbers aren’t used for taxation or licensure purposes, they aren’t required to practice medicine or run a healthcare practice. They’re limited to insurance matters.
HIPAA Provisions Generally Require NPI Numbers
Most healthcare providers within the U.S. are required to use an NPI under HIPAA regulations, although the number isn’t strictly required in all circumstances. Healthcare providers generally don’t need a number if they meet one of the following criteria:
- Are not covered by HIPAA
- Opt-out of Medicare/Medicaid
- Take no third-party payments
Few providers meet these criteria, as they preclude any insurance payments. Before submitting a Medicare, Medicaid or private health insurance claim, individual service providers need an NPI number.
NPI numbers are used both for individual service providers and healthcare businesses/organizations. Physicians, nurse practitioners, dentists, chiropractors, and other providers need a number, as do hospitals, laboratories, pharmacies, nursing homes, and home healthcare agencies.
How to Apply for an NPI Number
Applying for a national provider identification number has no cost and takes approximately 20 minutes. You can apply online, by mail, or through a CMS contractor. An online or CMA contractor application is recommended as it’s more convenient and faster.
You will receive an NPI number in 1-3 weeks. Electronic applications take around 10 days to process, and paper applications take around 20 days. Processing times vary depending on the current submission volume.
Once you have an NPI number, the number doesn’t expire and will be used no matter where in the country you do locum tenens work.
To learn more about NPI numbers, review the application questions carefully and consult the helpful FAQ.