NPI - National Provider Identifier

For the most up to date information, including information on the Medicare Fee-for-Service contingency plan, go to the CMS website at: www.cms.hhs.gov/NationalProvIdentStand (CMS Message 200705-28)

The comprehensive source for Medicare National Provider Identifiers (NPI)

NPI Registry-National Plan & Provider Enumeration System (NPPES)

Important CMS Announcements

As of May 23^rd, the NPI is Required for all HIPAA Standard Transactions. This means:

• For all primary and secondary provider fields, only the NPI will be accepted and sent on all HIPAA electronic transactions (837I, 837P, NCPDP, DDE, 276/277, 270/271 and 835), paper claims (UB-04 and CMS-1500) and SPR remittance advice.
• The reporting of Medicare legacy identifiers in any primary or secondary provider fields will result in the rejection of the transaction.

Stay up-to-date with the latest information from CMS.

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What is the NPI?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated that the Secretary of Health and Human Services adopt a standard unique health identifier for health care providers. On January 23, 2004, the Secretary published a Final Rule that adopted the National Provider Identifier (NPI) as this identifier.

All HIPAA covered healthcare providers, whether they are individuals or organizations, must obtain an NPI for use to identify themselves in HIPAA standard transactions. Once enumerated, a provider's NPI will not change. The NPI remains with the provider regardless of job or location changes.

Health care providers may use only their NPIs to identify themselves in standard transactions, where the NPI is required.

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NPI Updates

• NPI Related MLN Matters Articles
• Check the FAQ's for billing tips using NPI, as well as the 1500 Billing Guide in the publications section of this website.

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NPI Web Sites

• National Provider Identifier (NPI) Information for Medicare Fee-for-Service Provider
  The CMS website page that consolidates all information on the NPI. Although the NPI information and educational materials on this web page have been developed for Medicare FFS providers, these resources may be useful to other health care providers.
• National Plan and Provider Enumeration System (NPPES) :
  The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. CMS has contracted with Fox Systems, Inc. to serve as the NPI Enumerator. The NPI Enumerator is responsible for dealing with health plans and providers on issues relating to unique identification.
• Health Insurance Portability and Accountability Act (HIPAA) --- Identifiers & Standards   
  Includes all HIPAA Administrative Simplification information, including Frequently Asked Questions, NPI Final Rule, System of Records Notice, Announcements of Roundtables and industry events.
• Workgroup for Electronic Data Interchange (WEDI)
  An organization with whom the Secretary must consult when developing any of the HIPAA Administrative Simplification (AS) standards. WEDI has published several White Papers on the NPI, accessible through its website.

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05/01/2009