The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. The NPI is a unique identification number for covered health care providers. Covered healthcare providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.
As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.
The purpose of the National Provider Identifier (NPI) is to uniquely identify a health care provider in standard transactions, such as health care claims. NPIs may also be used to identify health care providers on prescriptions, in internal files to link proprietary provider identification numbers and other information, in coordination of benefits between health plans, in patient medical record systems, in program integrity files, and in other ways. HIPAA requires that covered entities (i.e., health plans, health care clearinghouses, and those health care providers who transmit any health information in electronic form in connection with a transaction for which the Secretary of Health and Human Services has adopted a standard) use NPIs in standard transactions by the compliance dates. The compliance date for all covered entities except small health plans was May 23, 2007; the compliance date for small health plans was May 23, 2008. As of the compliance dates, the NPI is the only health care provider identifier that can be used for identification purposes in standard transactions by covered entities.
Application on-line is encouraged. The application may be found and completed at: http://nppes.cms.hhs.gov. To request a paper application please contact: 800-465-3203 OR e-mail the request to customerservice [at] npienumerator.com.
The actual enumeration process is being performed by Fox Systems (the enumerator). Please contact the Enumerator for questions in regards to their internal procedures.
Yes. Under the NPI Final Rule (69 FR 3434), health care providers who are covered entities under HIPAA are required to obtain an NPI and to use it to identify itself as a health care provider in HIPAA transactions as of May 23, 2007. Small health plans were required to use the NPI since May 23, 2008. A health care provider is a covered entity if it transmits any health information in electronic form in connection with a transaction for which the Secretary has adopted a standard. For example, any health care provider (individual or organization) who sends electronic health care claims to a health plan(s),is a covered provider and must obtain an NPI. Health care providers who are not covered providers may elect to apply for NPIs, but are not required to do so. For the latest information regarding NPI issues for health care providers, visit this website: http://www.cms.hhs.gov/NationalProvIdentStand/
A health care provider may apply for an NPI in one of three ways:
1. Apply through a web-based application process. The web address to the National Plan and Provider Enumeration System (NPPES) is https://nppes.cms.hhs.gov.
2. If requested, give permission to have an Electronic File Interchange Organization (EFIO) submit the application data on behalf of the health care provider (i.e., through a bulk enumeration process). If a health care provider agrees to permit an EFIO to apply for the NPI, the EFIO will provide instructions regarding the information that is required to complete the process. More information on this option is available at: www.cms.hhs.gov/NationalProvIdentStand/04_education.asp#TopOfPage
3. Fill out and mail a paper application form to the NPI Enumerator. A copy of the application form (CMS-10114), which includes the NPI Enumerator’s mailing address, is available only upon request through the NPI Enumerator. The NPI Enumerator’s phone number is 1-800-465-3203 or TTY 1-800-692-2326.
When applying for an NPI, providers are encouraged to include their Medicare identifiers, but also those issued by any other health plans. If reporting a Medicaid identification number, include the associated State name. The legacy identifier information is critical for health plans in the development of crosswalks to aid in the transition to the NPI. Once the NPI application information has been submitted and the NPI assigned, NPPES (or an EFIO, if the health care provider was enumerated by way of an EFIO) will send the health care provider a notification that includes their NPI. This notification is proof of NPI enumeration and provides the information that will enable trading partners to verify a health care provider’s NPI.
Reviews are becoming a common place on the "Free Internet". Unfortunately, there are those who abuse this and any other privileges made available to them. We recognize this problem and encourge you to review your profile from time to time. If you find that a review has been submitted unjustly or in retaliation for whatever reason or simply in malice, feel free to notify us at (abuse[at]npidb.org) and we will formally review your request for removal. If we find your request to be reasonable and the review unjustified, we may, at our sole discretion, honor your request. Always include your NPI number whenever you are contacting us.
We encourge our users to express themselves and share their individual experiences on our site. Finding a good healthcare provider can be difficult and a time-consuming process, so hopefully with the help of others, we can help simplify this process for everyone else.
It is not our intent to display your personal information. We respect your right to privacy and we will never, knowingly, display your personal & confidential information to the general public. The information we display on this site is based on the information you filled out while applying for an NPI number from the CMS. The address and phone number(s) are extracted from the practicing address fields in your application. If you find that this information is incorrect or should not be published at all, simply email us and we will be happy to make the necessary changes or remove your profile altogether, if that is what you wish. You can also refer to our corrections page to make these changes online.
Yes - Your privacy and safety is our primary concern. If you feel uncomfortable having any of your personal information listed on our web site, you may submit a request for removal and upon verification, we will remove your NPI information from NPIdb.org. However, we will continue to provide the NPI number look up service to all our customers which will contain your NPI number, City & State of practice, Credentials and your primary specialty. Also, please be aware that although your information can be removed from NPIdb.org, that information is readily available to the public at the National Plan & Provider Enumeration System as well as many other web sites, therefore you may want to check with the NPPES to see what options you have available in protecting your privacy.
To submit a request for removal, please click here. Upon verifiation, your profile information will be removed from our web site as soon as reasonably possible.