09 June 2008

NPI and Medicare

All Individuals and Organizations who meet the definition of health care provider as
described at 45 CFR 160.103 are eligible to obtain a National ProviderIdentifier, or NPI. 

A detailed overview of covered entities is available at : link 

The NPI is a 10-digit number that will be used to identify health care partners,
including all payers, in all HIPAA standard transactions.  There are two types of health care providers in terms of NPIs:
  • Type 1—Health care providers who are individuals, including physicians, dentists, and all sole proprietors. An individual is eligible for only one NPI. 
  • Type 2—Health care providers who are organizations, including physician groups, hospitals,  nursing homes, and the corporation formed when an individual incorporates him/herself. 
Once you obtain your NPI and you will share it with your health care partners and it has to be integrated into their systems and procedures.  

NPI has significant benefits :
  • 10-position identifier (9 plus a check digit in the 10th position).  The ISO standard check digit will detect keying and data entry errors.
  • The numeric NPI will facilitate telephone keypad entry.
  • NPI will not contain intelligence about the health care provider’s organization. 
  • It is unique, permanent  and specific to a provider
You can look up an NPI using free services such as nebo.com at this link or at NPPES site

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