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A way to standardize, and simplify HIPAA administration & transactions

The National Provider Identifier is an identification number for covered healthcare providers. A unique, 10-digit number not containing personal information pertaining to the provider it belongs to, but rather as a way to assign responsibility to the provider for transactions conducted under HIPAA compliance, and identifying themselves as a healthcare provider without releasing personal information. 

What an NPI is typically used for

A provider may use an NPI for a few common reasons...

  1. Documenting HIPAA transactions. 
  2. Standardized way of identifying themselves as a healthcare provider. 
  3. Health care plans 
  4. Employers record 
  5. Assigning responsibility when conducting HIPAA transactions (especially financial)

Who is required to have an NPI

Any HIPAA-covered entity, including...

  • Healthcare providers conducting transactions electronically
  • Healthcare clearing houses
  • Health plans including but not limited to: Commercial plans / Medicare / Medicaid 

Do I need an NPI

If you do not meet the definition of a healthcare provider as outlined in 45 CFR 160.103, you won't have an NPI or have the ability to obtain one. 

For more information, please refer to the official documentation

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