Whether you're a resident, medical student, or are starting your career as a physician, you'll need to have a National Provide Identifier number. This number will be used any time you transmit certain pieces of information required by HIPAA regulations. Here's what you need to know about NPIs, what they're used for, and how to get one.
What is an National Provider Identifier?
Whether you plan to work in a private practice, in a hospital, or as a locum tenens physician, all healthcare providers who are HIPAA-covered entities — and those who bill Medicare for their services — must have a National Provider Identifier (NPI).
This 10-digit number is a unique, government-issued, standard identification number for individual healthcare providers that does not expire or change. Provider organizations like clinics, hospitals, pharmacies, schools, and group practices can also have NPI numbers.
Why do I need a National Provider Identifier?
You will need an NPI number prior to submitting claims or conducting other transactions as specified by HIPAA, including the situations listed below:
- Claims and encounter information
- Claims status
- Coordination of benefits and premium payment
- Eligibility, enrollment, and disenrollment
- Payment and remittance advice
- Referrals and authorizations
For more information, refer to the Transactions Overview page.
Do I need an NPI as a resident, intern, or medical student?
As healthcare providers, residents, interns, and medical students, you are all eligible to apply for an NPI. If you transmit any kind of health data for a HIPAA-standard transaction, you are required to have one. For example, if you are prescribing medications for patients that are filled by pharmacies, ordering tests for patients for other healthcare providers, or referring patients to other providers, you need to have an NPI number.
What information do I need to apply for an NPI?
Before you submit your application, ensure you have the following pieces of information:
- Reason you're submitting the application
- Identifying information, including name, SSN and/or ITIN
- Name of your organization, including EIN
- Mailing and practice location addresses
- Other provider identification numbers you have, if applicable
- 10-digit provider taxonomy code.
How do I apply for a National Provider Identifier?
Applying for your NPI number is free. You can apply online, by mail, or through a designated CMS contractor. The online application is recommended because it is generally quicker and easier to track the status.
1. Online: Apply through National Plan and Provider Enumeration System (NPPES).
2. By Mail: Complete, sign, and mail a paper NPI Application/Update Form to
7125 Ambassador Road Ste 100
Mill, MD 21244
3. Designated CMS contractor: Give permission to an Electronic File Interchange Organization (EFIO) to send application data through bulk enumeration process.
The NPPES website also contains frequently asked questions and other helpful information.
How will I receive my NPI number?
After your application has been accepted, you will receive your NPI via email from Customerservice@NPIEnumerator.com. Be sure to check your spam folder regularly — or add this email address to your trusted sender list — so you don’t miss it.
How long does it take to get an NPI?
The amount of time it takes to obtain an NPI is dependent upon the volume of applications being processed at a given time, whether the application was submitted electronically or on paper, and whether the application was complete. A provider who submits a properly completed electronic application could have an NPI in 10 days. The paper application process takes approximately 20 business days.
Where can I get more information about an NPI?
To obtain your National Provider Identifier, go to http://nppes.cms.hhs.gov/ or call customer service at 800.465.3203. Questions about the status of an NPI application may be emailed to customerservice@NPIEnumerator.com.
Are you looking for your first physician job? Check out CompHealth's available jobs for permanent or temporary physician jobs.
Last updated 6/29/2023