when is npi required

National Provider Identifier - Wikipedia, the free encyclopedia


** National Provider Identifier **

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A *National Provider Identifier* or *NPI* is a unique 10-digit
identification number issued to health care providers in the United States
by the Centers for Medicare and Medicaid Services (CMS). The NPI has
replaced the unique provider identification number (UPIN) as the required
identifier for Medicare services, and is used by other payers, including
commercial healthcare insurers. The transition to the NPI was mandated as
part of the Administrative Simplifications portion of the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), and CMS began issuing
NPIs in October 2006.^[1]


· 1 Mandated Uses
· 2 Optional Uses
· 3 Signup Process
· 4 Identifier Details
· 5 Open Data Set
· 6 Use as a data key
· 7 Notes
· 8 External links

*Mandated Uses[edit]*

HIPAA covered entities such as providers completing electronic
transactions, healthcare clearinghouses, and large health plans were
required by regulation to use _only_ the NPI to identify covered healthcare
providers by May 23, 2007. CMS subsequently announced that as of May 23,
2008, CMS will not impose penalties on covered entities that deploy
contingency plans to facilitate the compliance of their trading partners
(e.g., those healthcare providers who bill them). The posted guidance
document can be used by covered entities to design and implement a
contingency plan. Details are contained in a CMS document entitled,
"Guidance on Compliance with the HIPAA National Provider Identifier (NPI)
Rule." Small health plans have one additional year to comply.

All individual HIPAA covered healthcare providers (physicians, pharmacists,
physician assistants, midwives, nurse practitioners, nurse anesthetists,
dentists, denturists, chiropractors, clinical social workers, professional
counselors, physical therapists, athletic trainers etc.) or organizations

Source: en.wikipedia.org/wiki/National_Provider_Identifier

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