National Provider Identifier
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HIPAA mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. The Secretary adopted the NPI. The NPI is a numeric 10-digit identifier, consisting of 9 numbers plus a check-digit in the 10th position. It is accommodated in all standard transactions, and contains no embedded information about the health care provider that it identifies. Effective May 23, 2007, the NPI will be the only healthcare provider identifier that will be accepted/used for identification purposes for standard transactions by covered entities.
What is it?
A unique 10-digit number for every medical provider on a national level
Contains no “intelligence” about the provider
Replaces all “legacy” provider numbers that are currently being used including:
UPIN (Unique Physician/Practitioner Numbers)
Medicaid Provider Number
Medicare Provider Number-
Blue Cross and Blue Shield Numbers
Taxonomy:
The Health Care Provider Taxonomy code set is an external non medical data code set designed for use in an electronic environment, specifically within the ANSI ASC X12N health care transactions. This includes the transactions mandated under HIPAA.
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
The National Uniform Claim Committee (NUCC) is presently maintaining the code set. It is used in transactions specified in HIPAA and the National Provider Identifier (NPI) application for enumeration. Effective 2001, the NUCC took over the administration of the code set. Ongoing duties, including processing taxonomy code requests and maintenance of the code set, fall under the NUCC Code Subcommittee. Primary distribution of the code set remains the responsibility of Washington Publishing Company (WPC), through its web site.What is it?
A Taxonomy Code is an additional, unique, 10 position number to be listed on the NPI application
It provides additional information about the provider. The Taxonomy Code is structured into three distinct “Levels”–Level 1, Provider Type–Level II, Classification–Level III, Area of Specialization
For a complete list, click here
The Purpose of NPI
Establishes the standard for the unique health identifier for health care providers to simplify the administration of the health care system. Defines the National Provider Identifier (NPI) as the standard, and identifies the implementation specifications for obtaining and using the standard.
What the rule doesEstablishes the Standard: The National Provider Identifier (NPI) is the unique health identifier for health care providers. The NPI is a 10-digit numeric identifier with a check digit.
Establishes the National Provider System: The National Provider System (NPS) will be the system used to assign unique numbers to health care providers.
Defines Implementation Specifications for Covered Entities: Health Care Providers must obtain an NPI and use it on standard transactions; Health Plans and Health Care Clearinghouses must use the NPI to identify health care providers on standard transactions where the health care provider’s identifier is required.
Defines Compliance Dates for Implementation of the NPI: Health Care Providers, Health Plans (except small health plans), and Health Care Clearinghouses must comply with the NPI implementation specifications no later than May 23, 2007. Small Health Plans must comply with the NPI implementation specifications no later than May 23, 2008.
Do I need an NPI?
All health care providers that meet the definition of a covered entity (healthcare providers that conduct certain transactions in electronic form, health plans, or healthcare clearinghouses), as defined in 45 CFR 160.103, are eligible for NPIs. Health care providers who transmit any health information in electronic form in connection with a transaction are required to obtain and use NPIs. Health care providers who are not considered covered entities may also apply and be assigned an NPI. However, entities that do not provide health care (e.g., transportation services) are not eligible to be assigned NPIs because they do not meet the definition of “health care provider” and are not subject to HIPAA regulations.
If you provide services that fall within the realm of “Health Care” as defined by 45 CFR 160.103, you are required to obtain an NPI. This includes care, services, or supplies related to the health of an individual. Health Care includes, but is not limited to, the following:
Preventive, diagnostic, therapeutic, rehabilitative, maintenance, or palliative care, and counseling, service, assessment, or procedure with respect to the physical or mental condition, or functional status, of an individual or that affects the structure or function of the body; and
Sale or dispensing of a drug, device, equipment, or other item in accordance with a prescription. Examples include but are not limited to physicians, nurses, hospitals, physical and occupational therapists and pharmacies/pharmacists.
How do I get an NPI?
The National Plan and Provider Enumeration System (NPPES) is the contractor hired by CMS to assign and process the NPIs, to ensure the uniqueness of the health care provider, and generate the NPIs. To learn more about NPI and how to apply for an NPI click here.
Additional Information