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NPI Frequently Asked Questions

• What is an NPI?
• Is a healthcare provider required to obtain an NPI?
• Why do healthcare providers need NPI numbers?
• How can healthcare providers obtain an NPI?
• How many NPI numbers do healthcare providers need?
• What is my Primary Provider Taxonomy Code?
• How long will it take to receive an NPI?
• How can healthcare providers report NPIs to First Choice?
• Where can I find more information about the NPI?

An NPI is a 10-digit, intelligence-free numeric identifier. Intelligence-free means that the numbers do not carry information about healthcare providers, such as the state in which they practice or their specialization. NPIs will replace healthcare provider identifiers that are currently being used for HIPAA standard transactions. Those numbers include payor-specific IDs and Medicare legacy IDs (e.g. UPIN, OSCAR, PIN, and National Supplier Clearinghouse or NSC). A provider's NPI will not change and will remain the same regardless of job or location.

Yes. Under the NPI Regulation (published in the Federal Register on January 23, 2004), a healthcare provider who is a covered entity, as defined at 45 C.F.R. § 160.103, and who transmits any health information in connection with a standard transaction, is required to obtain an NPI.

HIPAA required the adoption of a standard identifier to allow for simpler electronic transmission of HIPAA standard transactions and more efficient coordination of benefits transactions. By May 23, 2007, the NPI will be the only healthcare provider identifier used for identification purposes in standard electronic transactions by covered entities.

Providers who have not yet obtained their NPI may apply for it in one of the following ways:

A web-based application that takes about 20 minutes to complete online at https://nppes.cms.hhs.gov.

A paper application that may be downloaded from https://nppes.cms.hhs.gov, or you can call the NPI Enumerator call center at 800.465.3203 to request a paper application.

An electronic file submitted by an organization. You must have the healthcare provider's permission to apply for an NPI by this method.

An individual is eligible for a single NPI. An individual cannot have subparts and cannot designate subparts. In terms of NPI assignments, an individual is an Entity Type 1 (Individual).

A sole proprietor/sole proprietorship is eligible for a single NPI. A sole proprietor/sole proprietorship cannot have subparts and cannot designate subparts. In terms of NPI assignment, a sole proprietor/sole proprietorship is an Entity Type I (Individual).

Organizations must also apply for a single NPI. In terms of NPI assignment, organization healthcare providers who are covered entities under HIPAA must apply for NPIs as Entity Type 2 (Organizations). Organization healthcare providers are corporations or partnerships or other types of businesses that are considered separate from an individual by the state in which they exist. Subparts of such organization healthcare providers who apply for NPIs are also Entity Type 2 (Organizations).

A subpart must have its own NPI if it conducts any HIPAA standard transactions separately from the covered organization healthcare provider of which it is a part. If your organization has subparts, make sure they obtain their own unique NPIs or get the NPIs for them. For further clarification about entity types and subparts, visit the Centers for Medicare and Medicaid Services (CMS) website at http://new.cms.hhs.gov/NationalProvIdentStand. Select the Medicare NPI Implementation link and then the Medicare Subpart Expectations PDF.

The Provider Taxonomy is an alphanumeric code, 10 characters in length that allows a single provider (individual, group or institution) to identify the specialty category. For more information, visit: http://www.wpc-edi.com/taxonomy.

CMS cannot predict the amount of time it will take to obtain an NPI due to several factors-such as the volume of applications being processed, how the applications are submitted and if the applications are complete and free of errors. CMS estimates that, in general, a healthcare provider who submits a properly completed electronic application could have an NPI within 10 days.

You should report your NPIs to First Choice by completing and returning the First Choice National Provider Identifier Submission Form.

Visit the CMS website, http://new.cms.hhs.gov/NationalProvIdentStand, for additional information.