In previous posts, I mentioned
something called an NPI number. NPI stands for national provider identifier.
Similar to how you and I are identified by our social security numbers for many
things, the NPI is a nationally recognized identification number for medical
care providers including doctors, nurse practitioners, hospitals, laboratories,
physical therapists and even insurance
companies. If a medical provider does
not have an NPI, one must be obtained in order to credential the provider with
any insurance company.
NPI
numbers are assigned and maintained by a division of the Centers for Medicare
and Medicaid Services (CMS), called NPPES or the National Plan and Provider
Enumeration System. The NPI application can be completed online at the NPPES
website (https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions).
To enroll for an NPI, you will need some information from the provider
including: Provider Name, Social Security Number or ITIN if not eligible for
SSN, Provider Date of Birth, Country of Birth, State of Birth (if Born in the U.S.), Provider Gender, Mailing Address, Practice Location Address and
Phone Number, Taxonomy ( This is the provider type or specialty. A list can be
found at http://www.wpc-edi.com/codes/taxonomy),
State Medical License, and Contact Person information.
To
apply for the NPI initially, create an
account on NPPES website and enter all of the information listed above in to
the NPPES web application. Be sure to keep the NPPES website account log in
information safe as you will need it later when credentialing with Medicare and
for Meaningful Use registration. Assuming you entered all of the information
correctly, the NPI number will be emailed to the contact person in just a few
days. Kudos to CMS as this is the easiest, fastest, and most reliable part of
credentialing!
Every
provider will need one individual NPI number. The individual NPI identifies
the provider. At times, the provider may belong to or wish to form a group
practice (multiple providers working together as a single business entity). If the provider is part of a group or wants to
form a group , you may also need to apply for a group NPI. In a former post, I gave the
first name/last name analogy. For clarity, I will explain that again. The Individual
NPI is like your first name. Your first name identifies you as an individual.
The Group NPI, is like your last name. Your last name identifies the family to
which you belong as a member.
Applying
for a group NPI is just like applying for an individual NPI. You will go to the
same website and need similar information as mentioned above. The difference is
that rather than using information belonging to a single person, you will use
the business’ information. Further, as a business is not born in the
traditional sense, you will not need to indicate the place of birth (I know,
that was probably obvious to you before I said it). As an additional side note,
in the event that a provider who has no individual NPI is joining an existing
group that already has an NPI, you do not need to apply for another group
NPI. The existing NPI is sufficient. You
will only need to apply for the individual NPI in that case. Using the name analogy again, this is like a new born baby. You only need to give the new baby a first name - the last name is already taken care of by the parents.
Only
AFTER you have gotten all required NPI numbers (individual and group, if
applicable), then you can begin credentialing with each insurance company
individually. More on that is coming soon…
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