NPI number (National Provider Identifier)

CMS explains that the Health Insurance Portability and Accountability Act (HIPAA) of 1996 required a standard unique identifier for health care providers, and the NPI Final Rule of January 23, 2004 adopted the NPI. It is a 10-digit number. CMS says NPIs do not carry information about a provider, such as location or specialty, and that once assigned an NPI stays the same even if your name, address or other details change.

The National Plan and Provider Enumeration System (NPPES), maintained by CMS, assigns NPIs and stores them. Health plans, including Medicare, Medicaid and private insurers, require NPIs in their administrative and financial transactions.

CMS says all health care providers who are HIPAA-covered entities, whether individuals or organizations, must obtain an NPI, and that all health care providers may obtain one. There are two types:

• Type 1: individuals, such as physicians and nurse practitioners. An individual can have only one.
• Type 2: organizations, such as hospitals, nursing homes and physician groups, which can have several.

For an international medical graduate, the NPI usually comes up at the start of residency, because hospitals need it to bill and prescribe; a CMS booklet says students, interns and residents are eligible. CMS gives nurse practitioners as an example of individual providers who get one. The NPI is not a license: you still need state licensure.

1. Create an account in the Identity & Access (I&A) system and log in to NPPES at nppes.cms.hhs.gov. CMS says the online application is the fastest way to receive an NPI.
2. Enter your details, including your taxonomy (provider type) and practice location.
3. Alternatively, mail the paper NPI Application/Update Form, CMS-10114, to the NPI Enumerator.
4. Or let your employer or another trusted organization obtain it for you through bulk enumeration or Electronic File Interchange (EFI).

The CMS-10114 instructions say that if you do not qualify for a Social Security number, you give your IRS Individual Taxpayer Identification Number with a copy of a US driver's license or state ID, and that visas are not acceptable as proof of identity. CMS's NPI pages do not list an application fee, and the public NPI Registry is free to search.

CMS says covered providers must report any change to their NPI information within 30 days. The NPI follows you between employers and states. CMS also says updating NPPES does not update your Medicare enrollment, which is a separate process.

• Applying twice. An individual is eligible for only one NPI.
• Assuming an NPI means you can practice or be paid. CMS says it does not ensure licensing or credentialing, guarantee payment or enroll you in a health plan.
• Out-of-date addresses after a move.

See our doctors in the USA and nurses in the USA pages.