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Healthcare Providers Need An NPI Number?

Healthcare service providers should ensure compliance with standards such as insurance credentialing and HIPAA when entering the field. Obtaining an NPI number tops the list.

All healthcare providers must obtain a National Provider Identification (NPI) number. The NPI is a 10-digit number that is unique to each provider. It is assigned by the Centers for Medicare and Medicaid Services (CMS) and is used to identify providers in all health plans, clearinghouses, and other healthcare provider transactions.

This blog post will explore the truth behind the NPI number and how it can benefit your practice.

Why Are NPI Numbers Needed?

Healthcare providers, health records clearinghouses, and healthcare organizations must obtain an NPI if they use or conduct transactions subject to HIPAA regulations.

An NPI number is required for any individual, business, or healthcare agency that transmits patient health information electronically. It includes all medical billing companies and organizations that process claims on behalf of their clients. An NPI is meant to improve healthcare efficiency and reduce fraud and abuse.

Is It A Hipaa Violation Not To Have An NPI?

Under HIPAA, healthcare providers are required to have standard national numbers. HIPAA requires covered healthcare providers to have a National Provider Identifier (NPI). NPIs are used in administrative transactions under HIPAA by covered healthcare providers, health plans, and clearinghouses. HIPAA prohibits practices without NPIs.

Two Types Of NPI Providers’ for the link

HIPAA designates two categories of entities as NPI providers:

  • Type-1 NPI includes individuals needing an NPI number to identify as health care service providers. Type 1 is the billing category for individual service providers, such as physicians, dentists, chiropractors, physical therapists, and nurse practitioners.
  • Type-2 NPI: This group contains organizations that have incorporated and may include critical care facilities, health systems, hospitals, and physician groups.

NPI Number Enrollment

An NPI number can be obtained by submitting an online application. You should be able to complete the application in about 20 minutes. Applying online is strongly recommended because it speedily tracks the processing of your application. Another way providers can apply for an NPI number is through a paper form on behalf of the organization.

NPI Number Eligibility

Health care providers who meet the definition of a health care provider as defined by 45 CFR 160.103 may obtain a National Provider Identifier (NPI).

Whether you are a  health care provider, supplier billing federally funded programs for services or HIPAA-covered provider,(or not), if your business is engaged in any activity involving exchanging information about patients/clients and their health status to receive payment, it needs an NPI.

To enroll with Medicare, providers must obtain a National Provider Identifier (NPI). All healthcare professionals—doctors, suppliers, and hospitals alike—can get an NPI.


If you’re a healthcare provider and own your practice, you absolutely need an NPI number. Having an NPI number is very important because some medical claims and other healthcare-related documents require the provider’s NPI number. If your practice doesn’t have an NPI number, you won’t be able to submit claims for reimbursement.

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