NPI (National Provider Identifier) is a unique 10-digit identification number assigned to healthcare providers by the Centers for Medicare and Medicaid Services (CMS) in the United States. The purpose of NPI is to simplify provider identification within electronic healthcare transactions and ensure standardization across various healthcare programs and organizations.
The NPI was implemented as part of the Health Insurance Portability and Accountability Act (HIPAA) in 2003, replacing previous provider identification numbers. It is utilized by healthcare providers, health plans, clearinghouses, and other healthcare organizations involved in electronic claims processing, billing, and other administrative transactions. The NPI applies to a wide range of healthcare professionals, including physicians, nurses, dentists, chiropractors, psychologists, and more.
The NPI is divided into two categories: Type 1 and Type 2. Type 1 NPI is assigned to individual healthcare providers, while Type 2 NPI is assigned to organizations such as hospitals, clinics, group practices, or any entity that bills for healthcare services. Each healthcare provider or organization is assigned only one unique NPI, which remains consistent regardless of changes in employment, location, or specialty.
By using the NPI, healthcare providers and organizations can streamline administrative processes, reduce paperwork, and promote efficient communication within the healthcare system. It ensures accurate identification, improves patient privacy, and assists in preventing fraud and abuse by linking providers to their services in a consistent and standardized manner.
