What Is National Provider Identifier (NPI)? - Definition From

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• Hannah Nelson, Xtelligent/TechTarget
• Tayla Holman, Site Editor

Published: Jul 11, 2024

What is a national provider identifier (NPI)?

A national provider identifier (NPI) is a unique ten-digit identification number required by the Health Insurance Portability and Accountability Act (HIPAA) for covered healthcare providers in the United States.

Covered healthcare providers, health plans and healthcare clearinghouses -- public or private entities that process or facilitate the processing of health information -- must use NPIs in administrative and financial transactions adopted under HIPAA.

What is the purpose of an NPI?

This number's sole purpose is to facilitate organization and create national standards within HIPAA transactions; however, it is possible to use a provider's NPI to search for their National Plan and Provider Enumeration System (NPPES) information. The NPI itself is an intelligence-free number -- it carries none of the holder's personal identification other than a name and business address.

Having an NPI does not guarantee that a provider is licensed, but all licensed providers must have an NPI.

How did the NPI come into existence?

The NPI came into existence as part of HIPAA's administrative simplification standards for information transactions and data elements. HIPAA mandates that the U.S. Department of Health and Human Services, i.e. HHS, secretary adopt criteria for a standard unique identifier for each individual, employer, health plan and healthcare provider for use in the healthcare system.

The NPI replaces the unique physician identification number (UPIN), a six-character identifier Medicare used to ascertain doctors in the U.S. who accepted Medicare insurance. Centers for Medicare & Medicaid Services (CMS) discontinued the use of UPINs in June 2007.

Who must obtain an NPI?

All healthcare providers who are HIPAA-covered entities, whether individuals or organizations, must get an NPI.

Who may not obtain an NPI?

Entities that do not meet the definition of a healthcare provider as defined by HIPAA may not apply for an NPI.

What are the healthcare provider NPI categories?

There are two healthcare provider categories for NPI enumeration:

• Individual or Type 1. This category includes individuals who render healthcare services, such as physicians, nurses, dentists, pharmacists and sole providers.
• Organization or Type 2. This category includes organizations that render healthcare services or provide healthcare supplies to patients, such as hospitals and home health agencies.

Editor's note: This article was written by Tayla Holman in 2017. TechTarget editors revised it in 2024 to improve the reader experience.

Continue Reading About national provider identifier (NPI)

• NPI: What You Need to Know

• Types of NPIs

• AAFP: National Provider Identifier

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