Trading Partners
National Provider Identifier (NPI)
The administrative simplification provisions of HIPAA require the Secretary of Health and Human Services (HHS) to adopt a national standard identifier for covered health care providers. The National Provider Identifier (NPI) will be the standard identifier and CMS is developing the National Plan and Provider Enumeration System (NPPES) to identify providers and assign NPIs.
The NPI will be a ten-digit number and will be used to submit claim transactions to all government and non-government payers. It will eventually replace existing provider numbers assigned by these entities and CMS will discontinue the UPIN enumeration process.
Providers who will be required to obtain an NPI include physicians, non-physician healthcare practitioners, other suppliers and certified providers such as institutions, home health agencies and skilled nursing facilities. Each individual practitioner will receive one NPI. However, an organizational provider may obtain an NPI for each of its subparts. A subpart can be considered a separate physical location of an organization health care provider, member of a chain or an organization health care provider separately licensed or certified.
Starting May 23, 2005, all health care providers can apply for their National Provider Identifier (NPI). The NPI will replace health care provider identifiers in use today in standard health care transactions. All Health Insurance Portability
and Accountability Act (HIPAA) covered entities except small health plans must begin using the NPI on May 23, 2007; small health plans have until May 23, 2008. For additional information, and to complete an application, visit https://nppes.cms.hhs.gov on
the web. It is important to note that the Medicare program is not accepting the NPI in standard transactions yet. Explicit instructions on time frames and implementation of the NPI for Medicare billing will be issued later in 2006. Other health plans with whom you do business
will instruct you as to when you may begin using the NPI in standard transactions.
Please continue to watch this site for additional information or sign-up for the NPI e-mail list to be notified via e-mail when updates are made to this NPI information.