NPI Q&A
1. What is the NPI?
2. What are the advantages of the NPI?
3. How is my NPI determined?
4. Who is required to apply for an NPI?
5. Will the NPI replace other numbers I use?
6. How do I apply for my NPI?
7. What do I do with my NPI once I have it?
8. Where can I go for additional help and information?

1. What is the NPI?

The National Provider Identifier (NPI) is part of the Health Insurance Portability and Accountability Act (HIPAA). The NPI regulation establishes one unique identifying number for each health care provider. This simplification measure will pare down the number of identifiers currently used in health care transactions.

2. What are the advantages of the NPI?
 
Use of the NPI will have several advantages, including:
  • One unique provider identifier for all health plans to utilize
  • A permanent provider identifier that will not change in the event of practice relocation or changes in specialty
  • An easier process for health plans to track transactions and avoid duplication
3. How is my NPI determined?

The NPI is a random ten-digit number (nine digits plus a check digit to detect keying errors). It never expires. It contains no inherent information about the provider, such as state of residence or license number. NPI numbers are administered by the Centers for Medicare and Medicaid Services (CMS), which has contracted with the National Plan and Provider Enumeration System (NPPES). The federal government is also responsible for assisting providers in completing the application and resolving problems associated with an NPI.

4. Who is required to apply for an NPI?
 
The broad definition of health care "provider" in the federal regulation encompasses all who provide health care services. Please note: Although dental assistants and hygienists are "providers" and are thus eligible to obtain an NPI, they are only required to do so if they submit claims for their services.

In Minnesota: Because of Minnesota Statute 62J.54, all Minnesota providers must use their NPI on paper and electronic claims. Therefore, all billing providers in Minnesota must apply for an NPI and understand the requirements for its use. 

In other states: Use of the NPI by providers is required for electronic claims only.

There are two types of NPIs.

  • Type 1: Individuals (such as physicians, dentists and pharmacists)
    - No two individuals can have the same NPI and no individual person can have more than one Type 1 NPI.
  • Type 2: Organizations or Corporations (such as hospitals and clinics)
     -  Only needed if the organization or corporation does the billing.

You will use the NPI to designate:

  • Treating Provider - always use the Type 1 NPI of the dentist providing care. This cannot be a Type 2 NPI.
  • Billing Provider - the entity doing the billing
    -  Use Type 1 NPI if the chief dentist does the billing for all dentists.
    -  Use Type 2 NPI if the organization or corporation does the billing.

General rules:

  • If the Billing Provider is different from the Treating Provider, and the Billing Provider is a corporation or organization, then the corporation should get a Type 2 NPI.
  • Practices that are sole proprietorships should not get a Type 2 NPI. The proprietor should get one Type 1 NPI and use it for both the Billing Provider and Treating Provider.
  • If the Billing Provider is different from the Treating Provider, and both are individual dentists, submit the appropriate Type 1 NPI in each field.

5. Will the NPI replace other numbers I use?

The NPI will replace other identifying numbers currently used in electronic transactions, such as your:

  • Numbers issued by plans and insurers (e.g. Blue Cross and Blue Shield number)
  • Medicaid provider number
  • Medicare provider number
  • CHAMPUS number
  • Other "legacy" identification numbers
The NPI will not replace numbers used for purposes other than general identification, such as your:
  • Social Security Number
  • DEA number
  • Taxpayer ID number
  • Taxonomy number
  • State license number
The NPI will replace all other identification numbers, but your Taxpayer ID number (or Social Security Number) will still be required for 1099 purposes.

6. How do I apply for my NPI?
 
You only apply for your NPI once, and your NPI is permanently assigned for your lifetime. There is no cost to apply.

You may apply for your NPI either:
  • Online: Complete a web application and submit it electronically
  • On Paper: Print an Adobe Acrobat (PDF) version of the application and mail it to the address provided. You may also call NPPES to have an application sent to you. Call 1-800-465-3203 or TTY 1-800-692-2326.
When you apply for your NPI, you will be asked to provide your 10-digit taxonomy code. For quick reference, here are the dental taxonomy codes:
  • General Practice - 1223G0001X
  • Dental Public Health - 1223D0001X
  • Endodontics - 1223E0200X
  • Oral and Maxillofacial Pathology - 1223P0106X
  • Oral and Maxillofacial Radiology - 1223X0008X
  • Oral and Maxillofacial Surgery - 1223S0112X
  • Orthodontics and Dentofacial Orthopedics - 1223X0400X
  • Pediatric Dentistry - 1223P0221X
  • Periodontics - 1223P0300X
  • Prosthodontics - 1223P0700X
  • Denturist - 122400000X

After you receive your NPI, you must furnish any updates to the NPPES. If any of the data you submitted on your application changes, notify NPPES within 30 days of the change.

You may receive notices about the NPI from other health and dental plans, but your unique NPI is used with all plans. Remember to notify each dental plan of your NPI separately.

7. What do I do with my NPI once I have it?

If you haven’t done so already, please send us your NPI now so it won’t affect your claims. Please remember to continue to include your TIN and License on the claim.

Other health and dental plans may have differing timelines for NPI implementation, so take notice of each plan's requirements.

In addition, you will want to contact your clearinghouse for instructions about their transition plans for using the NPI.

8. Where can I go for additional help and information?
 
This Web site will have NPI updates so check back periodically. Also, watch your Special Edition newsletter for articles on the NPI.

Here are some helpful Internet resources: