When should I apply for an NPI number?

The National Provider Identifier or commonly known as NPI is a government issued 10-digit unique standard identification number that all Health Care Providers must use when submitting electronic claims effective May 23, 2008.

Individual healthcare providers, as well as provider associations such as clinics, hospitals, schools, and group practices, are assigned this number, which is specific and provided by the government. Before filing claims or engaging in other HIPAA-compliant transactions, you’ll need one.

Who May Get an NPI?

An NPI can be obtained by any health care provider (physicians, manufacturers, hospitals, and others). Individuals or entities that provide health care are classified as health care providers in 45 Code of Federal Regulations (CFR) 160.103.

Who Must Get an NPI?

All HIPAA-covered health care providers whether individuals or organizations must obtain an NPI.

You are considered as a covered health care provider when you electronically transmit health information in connection with a HIPAA standard transaction, even if you use a business associate to do so.

Do You Need an NPI to Enroll in Medicare?

Yes, indeed. You must have an NPI and include it on your enrollment application if you choose to enroll in Medicare. Enrollment applications without an NPI would be rejected by the NPI Enumerator.

Health Care Providers who are HIPAA-Covered Entities:-

When should I apply for an NPI number

Individuals

  • Chiropractors
  • Dentists
  • Nurses
  • Pharmacists
  • Physical Therapists
  • Physicians
  • Psychologists

Organizations

  • Ambulance Companies
  • Clinics
  • Group Practices
  • Health Maintenance Organizations (HMOs)
  • Home Health Agencies (HHAs)
  • Hospitals
  • Laboratories
  • Nursing Homes
  • Pharmacies
  • Residential Treatment Centers
  • Suppliers of Durable Medical Equipment (DME)

Who May Not Get an NPI?

Any organization that does not meet the 45 CFR 160.103 meaning of a health care provider is not eligible to apply for an NPI. Billing agencies, value-added networks, repricers, insurance plans, health care clearinghouses, non-emergency transportation services, and others are examples of such organizations.

NPI lookup Search If you want to do current NPI lookup by state then you can visit website NPPES https://nppes.cms.hhs.gov.

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