National Provider Identifier (NPI)
The National Provider Identifier (NPI) is a 10-digit identification number that federal government assigns to health care providers. It is one of the simplifications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to reduce fraud and improve the efficiency of the health care system.
All providers who complete electronic transactions must obtain an NPI to identify themselves in HIPAA standard transactions. These providers include:
- Physicians and other practitioners, including, but not limited to, dentists, physician assistants, chiropractors, nurses, licensed social workers, physical therapists, and clinical psychologists
- Hospitals, nursing homes and other institutional providers
- Suppliers of durable medical equipment (DME), pharmacies, including online pharmacies, and pharmacists medical groups
Network providers are required to submit claims electronically (excluding providers in Alaska) and, therefore, must submit claims with NPI numbers.
The NPI mandate allows TRICARE to require providers use NPIs on all transactions, including paper, to improve processing efficiency. Visit our NPI forms page to print and complete the West Region NPI form.
Obtaining an NPI
National Provider Identifiers are generated by a system called the National Plan and Provider Enumeration System (NPPES) and issued by the U.S. Department of Health and Human Services (HHS) through the Centers for Medicare and Medicaid Services (CMS).
Providers can get an NPI by contacting NPI Enumerator or by applying online.
- Web (NPPES): https://nppes.cms.hhs.gov
- Email: at email@example.com
- Phone: 1- 800-465-3203
- Mail: NPI Enumerator
PO Box 6059
Fargo, ND 58108-6059
To determine how many NPIs to request, please consider the following tips provided by CMS:
- Individuals (doctors, nurses, sole proprietors): One NPI per provider regardless of numbers of practice locations, contracts, etc. These are considered Type 1 NPIs*.
- Hospitals (organizations, physician groups, nursing facilities, etc.): One NPI or some/all subparts may also need to have NPIs. Hospitals should obtain separate NPIs for each Medicare A number (for example, home health, hospice, emergency room, mental health, rehab). Obtain separate NPIs for each unique reimbursement or contract methodology (for example, low volume psych, high volume psych, teaching differential). These are considered Type 2 NPIs.
- Clinics (group practices, etc.): Obtain separate NPIs per pay-to/mailing address. These are considered Type 2 NPIs.
- Durable medical equipment suppliers: Obtain one NPI per location. These are considered Type 2 NPIs.
*Individual providers who are incorporated may need to obtain an NPI for the individual (Type 1) and an NPI for the corporation or LLC (Type 2).
Note: The NPI number is the sole identifier for each provider and should replace each health plan identifier. Providers only need to apply for an NPI once. Also, if a provider changes specialty, practices or moves, he/she retains the same NPI number. The NPI number is meant to identify the provider throughout his/her career.
To learn more about NPI from CMS, visit the CMS website.