National Provider Identifier

The National Provider Identifier (NPI) is a unique, 10-position numeric identifier, issued by the Centers for Medicare and Medicaid Services (CMS) for covered health care providers.

The implementation of the NPI was part of the Administrative Simplifications section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

What is the purpose of the National Provider Identifier (NPI)?

The National Provider Identifier (NPI) is a unique identification number that was created to improve the efficiency of the exchange of electronic health care information. Prior to the implementation of NPI's, health care providers had different identification numbers depending on the entity. The inclusion of NPI numbers has all but eliminated the need for custom identification numbers.

What are the benefits of the National Provider Identifier (NPI)?

• Standard unique identifier for HIPAA-covered entities.
• Accepted by all payers
• Efficient coordination of benefits between health plans.

What a National Provider Identifier (NPI) does not do?

• Ensure the entity is licensed or credentialed.
• Guarantee any payment by a health plan
• Efficient coordination of benefits between health plans.

Who can apply of a National Provider Identifier (NPI)?

All health care providers (Individuals and Organizations) who are HIPAA-covered entities, must obtain a National Provider Identifier (NPI).

Entity Type 1 - Individual Health Care Examples

• Physicians
• Dentists
• Pharmacists
• Chiropractors
• Optometrists
• Physician Assistants
• Physical Therapists
• Clinical Social Workers

Entity Type 2 - Organizational Health Care Examples

• Hospitals
• Laboratories
• Pharmacy
• Medical Supply Companies
• Group Practices
• Home Health Care Agencies
• Nursing Homes
• Residential Treatment Centers

How do I get a National Provider Identifier (NPI)?

Please go here: https://nppes.cms.hhs.gov/ to enroll for a National Provider Identifier (NPI). The National Plan and Provider Enumeration System (NPPES) is responsible for assigning NPI numbers and maintaining the associated information about health care providers.

Once enrolled, how do I update my information?

Please go here: https://nppes.cms.hhs.gov/ to update your NPI file information. The National Plan and Provider Enumeration System (NPPES) is responsible for assigning NPI numbers and maintaining the associated information about health care providers.

Is there a way to search for an NPI?

In September 2007, CMS began disclosing NPPES health care provider data that are disclosable under the Freedom of Information Act (FOIA) to the public. Eclaims provides an up-to-date NPI Lookup Directory to assist you in finding Provider NPI information.

How to know if a number is actually an NPI or something else?

NPI numbers can be pre-validated using the ISO standard Luhn algorithm. Eclaims has implemented a NPI Validation Tool to pre-check any number.

Where can I learn more about the ISO standard Luhn algorithm?

The National Provider Identifier (NPI) check digit is calculated using the ISO standard Luhn algorithm, a modulus 10 algorithm. Eclaims has provided step-by-step instructions on how to calculate the NPI check digit.