National Provider Identifier Registry

Overview:

  • The National Provider Identifier (NPI) was adopted as the standard unique health identifier for health care providers to carry out a requirement in the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • The Centers for Medicare & Medicaid Services (CMS) then developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.
  • Any entity who meets the definition of a “health care provider” is eligible to receive a provider ID, or NPI.  That would mean any provider of medical or other health services, and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business.
  • Under HIPAA, a covered health care provider is any provider who transmits health information in electronic form in connection with a transaction for which standards have been adopted. These covered health care providers must obtain an NPI and use this number in all HIPAA transactions
  • The NPI Registry enables you to search for a provider’s NPPES information to retrieve read-only data. For example, users may search for a provider by the NPI or Legal Business Name.
  • It’s pretty well maintained. A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change.
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