NPI Number – Who Is Required to Have Them by May 23, 2007

NPI Number – Who Is Required to Have Them by May 23, 2007

Many people believe that the NPI number was initiated by the HIPAA Act of 1996. Actually, the NPI number was initiated by CMS (Centers for Medicare & Medicaid Services) in July of 1993. CMS wanted a national identification system for all healthcare providers and many of the existing identifiers did not meet the standards for national standards. The HIPAA Act of 1996 required the adoption and use of a standard unique identifier for healthcare providers. All covered healthcare providers will be required to have an NPI number by May 23, 2007.

The National Provider Identifier, or NPI, is a 10 position, all numeric, identification number assigned by the NPS to uniquely identify a healthcare provider. If you are an individual healthcare provider you will need to apply for an NPI number under your individual name. If you belong to a medical group, you will need an NPI number for the group and an NPI number for each individual healthcare provider in the group.

Medical Billing Services are not eligible for NPI numbers because they are not a covered healthcare provider. A covered healthcare provider is any provider who transmits any health information in electronic form.

NPI numbers will replace the healthcare provider’s Medicare provider number, Medicaid provider number, Champus provider number, UPIN number, and all other payors’ unique provider numbers (such as Blue Cross Blue Shield). NPI numbers will not replace tax id number or social security number, DEA number, taxonomy number, or license number.

Once an NPI number is assigned to a covered healthcare provider it will not change. NPI numbers will travel with a healthcare provider if they move from one geographical location to another. NPI numbers can be deactivated if the healthcare provider is deceased or goes out of business. NPI numbers will not be reissued to a different healthcare provider once they have been deactivated.

Covered healthcare providers can apply for their NPI number from now until May 23, 2007. Applications began being accepted in May of 2005. I strongly recommend that you apply immediately. There is no reason to put it off. The closer it gets to the deadline, the busier the application process will become.

Any changes in information need to be reported to NPPES within 30 days of the change.

NPI numbers can be obtained by completing an online application which takes about 20 minutes.