What is an NPI number?

HIPAA's administrative simplification rules created the NPI as the standard identifier for providers in electronic healthcare transactions, such as claims and eligibility checks. CMS runs NPPES, the system that assigns NPIs and stores provider details. The number itself carries no information about the provider. It stays with an individual for life, even if they move states, change specialties or change employers.

There are two types. Type 1 NPIs are for individuals, such as physicians, dentists, nurse practitioners and therapists. Type 2 NPIs are for organizations, such as group practices, clinics, hospitals and some subparts of organizations. A clinician in a group practice usually has their own Type 1 NPI, and the group has a Type 2 NPI.

NPPES records include name, practice location address, mailing address, phone number and taxonomy codes that describe the provider type and specialty. Providers are responsible for keeping their NPPES record updated when these details change.

An NPI is an identifier, not a credential. Having one does not show that a provider is licensed, board certified or enrolled with any insurer, so it should not be presented as a qualification in marketing. Medicare and Medicaid enrollment and insurer credentialing are separate processes.

Common mistakes include practices letting NPPES addresses go stale after a move, listing a billing office as the practice location, and forgetting to update phone numbers. Because NPPES data is public, practices should also avoid putting personal home addresses or phone numbers in it when a business address is appropriate. Add an NPPES check to your onboarding and offboarding steps for clinicians, next to Google Business Profile, website bios and insurer directory updates, so provider data changes everywhere at once.