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NPI Glossary of Terms
Prepared by Blue Cross and Blue Shield of Kansas
Bulk Enumeration – (also referred to as mass enumeration) Mass enumeration of a large number of health care providers, all at one time
Covered Health Care Provider – A person who is trained and licensed to give health care or a place that is licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.
Electronic File Interchange (EFI) Submitter – (also known as a bulk enumerator) group/organization who is certified to submit NPI applications in an electronic file. An EFI submitter might be a professional organization who when authorized by you, will submit electronic application for its members.
Employer Identification Number (EIN) – The number assigned by the Internal Revenue Service (IRS), or the provider being identified.
Entity Type Code – The type of health care provider that is being assigned an NPI. Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non person): entity other than an individual human being that furnishes health care (for example, hospital, skilled nursing facility, hospital subunit, pharmacy, or health maintenance organization)
Entity Type Code 1 – The type of NPI issued to health care providers who are human beings. Examples are physicians, dentists, nurses, chiropractors, pharmacists and physical therapists.
Entity Type Code 2 – The type of NPI issued to health care providers other than individual human beings, that is, organizations. Examples are hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, health maintenance organizations (HMO), suppliers of durable medical equipment, supplies related to health care, prosthetics and orthotics, and pharmacies.
Enumerator – An organization under contract with the Department of Health and Human Services to assign NPIs. The enumerator will:
- receive and process National Provider Identifier (NPI) applications;
- notify health care providers of their NPIs;
- use the National Plan and Provider System (NPPES) to ensure the unique identification of a health care provider;
- answer questions about the processes of applying for and obtaining NPIs and furnishing updates;
- collect information, via the applications and updates, and maintain the NPPES database containing NPIs and information about the health care providers to which they are assigned; and
- furnish information upon request and in accordance with established guidelines.
Individual Health Care Provider – Health care providers who are human beings. The providers are considered entity type code 1. Examples are physicians, dentists, nurses, chiropractors, pharmacists and physical therapists.
IRS Individual Taxpayer Identification Number (IRS ITIN) – The number assigned by the Internal Revenue Service (to individuals who are not eligible to be assigned SSNs) to the individual being identified.
Legal Entity – The covered entity ultimately responsible for complying with the HIPAA rules and for ensuring that its subparts and/or health care components are in compliance.
National Provider Identifier (NPI) – A system for uniquely identifying all providers of health care services, supplies, and equipment. NPIs are assigned by the NPPES and are 10-position, all-numeric identification numbers that will identify a health care provider i n standard transactions, such as health care claims.
National Provider System (NPS) – Now known as National Plan and Provider Enumeration System.
National Plan and Provider Enumeration System (NPPES) - The administrative system for supporting a national plan and provider registry. This is a comprehensive uniform system for identifying and uniquely enumerating health care providers and plans at the national level.
Nonhealth Care Services – Atypical or nontraditional services that are indirectly related to health care but do not fall within the definition of health care services. These could include taxi, home and vehicle modifications or insect control.
Organization Health Care Provider – Health care providers who are not individuals, that is, human beings. These providers are classified as entity type code 2 providers. Examples are hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, health maintenance organizations (HMO), suppliers of durable medical equipment, supplies related to health care, prosthetics and orthotics, and pharmacies.
Social Security Number (SSN)– A number assigned by the Social Security Administration (SSA) to the individual being identified.
Subpart – A component or separate physical location of an organization health care provider. Examples:
- subpart of a hospital could include outpatient departments, surgical centers, psychiatric units and laboratories;
- provider chains that generally have a corporate headquarters and a number of separate physical locations. The separate physical locations are generally separately licensed or certified, i.e. DME supplier chain.
Taxonomy Code - An administrative code set that classifies health care providers by type, classification and specialization.
Glossary updated May 23, 2005
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