A National Provider Identifier (NPI) is a unique 10-digit identification number issued to

health care Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

providers in the United States by the

Centers for Medicare and Medicaid Services The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer ...

(CMS). The NPI has replaced the Unique Physician Identification Number (UPIN) as the required identifier for Medicare services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the Administrative Simplifications portion of the

Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Ted Kennedy, Kennedy–Nancy Kassebaum, Kassebaum Act) is a United States Act of Congress enacted by the 104th United States Congress and signed into law by President ...

of 1996 (HIPAA).

Mandated uses

HIPAA–covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans were required by regulation to use only the NPI to identify covered healthcare providers by May 23, 2007. CMS subsequently announced that as of May 23, 2008, CMS will not impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners (e.g., those healthcare providers who bill them). The posted guidance document can be used by covered entities to design and implement a contingency plan. Details are contained in a CMS document entitled, "Guidance on Compliance with the HIPAA National Provider Identifier (NPI) Rule." Small health plans have one additional year to comply. All individual HIPAA–covered healthcare providers or organizations must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency prepares the transaction. Individual HIPAA–covered healthcare providers include

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

pharmacist A pharmacist, also known as a chemist in English in the Commonwealth of Nations, Commonwealth English, is a healthcare professional who is knowledgeable about preparation, mechanism of action, clinical usage and legislation of medications in ...

physician assistant A physician assistant or physician associate (PA) is a type of non-physician practitioner. While these job titles are used internationally, there is significant variation in training and scope of practice from country to country, and sometimes be ...

midwives A midwife (: midwives) is a health professional who cares for mothers and newborns around childbirth, a specialisation known as midwifery. The education and training for a midwife concentrates extensively on the care of women throughout their ...

nurse practitioner A nurse practitioner (NP) is an advanced practice registered nurse and a type of mid-level practitioner. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, prescribe medications an ...

nurse anesthetist A nurse anesthetist is an advanced practice nurse who administers anesthesia for surgery or other medical procedures. They are involved in the administration of anesthesia in a majority of countries, with varying levels of autonomy. Nurse anesth ...

dentist A dentist, also known as a dental doctor, dental physician, dental surgeon, is a health care professional who specializes in dentistry, the branch of medicine focused on the teeth, gums, and mouth. The dentist's supporting team aids in provi ...

denturist A denturist in the United States and Canada, clinical dental technologist in the United Kingdom and Ireland, dental prosthetist in Australia, or a clinical dental technician in New Zealand is a member of the oral health care team and role as ...

s, licensed opticians,

optometrist Optometry is the healthcare practice concerned with examining the eyes for visual defects, prescribing corrective lenses, and detecting eye abnormalities. In the United States and Canada, optometrists are those that hold a post-baccalaureate f ...

chiropractor Chiropractic () is a form of alternative medicine concerned with the diagnosis, treatment and prevention of physical disorder, mechanical disorders of the musculoskeletal system, especially of the vertebral column, spine. It is based on sever ...

s, clinical social workers, professional counselors,

physical therapist Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention ...

occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use evidence-based practice, scientific bases and a Holism, holistic perspec ...

s, prosthetists, orthotists,

pharmacy technician A pharmacy technician (PhT) performs pharmacy-related functions including but not limited to filling out prescription medications. Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in s ...

s and

athletic trainer An athletic trainer is a certified and licensed health care provider who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association The American Medical Association (AMA) is an American ...

s. Organizations include

hospital A hospital is a healthcare institution providing patient treatment with specialized Medical Science, health science and auxiliary healthcare staff and medical equipment. The best-known type of hospital is the general hospital, which typically ...

s, home health care agencies,

nursing home A nursing home is a facility for the residential care of older people, senior citizens, or disabled people. Nursing homes may also be referred to as care homes, skilled nursing facilities (SNF), or long-term care facilities. Often, these terms ...

residential treatment centers A residential area is a land used in which houses, housing predominates, as opposed to industrial district, industrial and Commercial Area, commercial areas. Housing may vary significantly between, and through, residential areas. These include ...

, group practices,

laboratories A laboratory (; ; colloquially lab) is a facility that provides controlled conditions in which science, scientific or technological research, experiments, and measurement may be performed. Laboratories are found in a variety of settings such as s ...

pharmacies Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medication, medicines. It is a miscellaneous science as it ...

and

medical equipment A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...

companies. Once assigned, a provider's NPI is permanent and remains with the provider regardless of job or location changes. Other health industry workers who provide support services but not health care (such as admissions and medical billing personnel, housekeeping staff and orderlies) are not required to obtain an NPI.

Optional uses

The NPI must be used in connection with the electronic transactions identified in HIPAA. In addition, the NPI may be used in several other ways: # by health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence; # by health care providers to identify other health care providers in health care transactions or on related correspondence; # by health care providers on prescriptions (however, the NPI will not replace requirements for the

DEA number A DEA number (DEA Registration Number) is an identifier assigned to a health care provider (such as a physician, physician assistant, nurse practitioner, optometrist, podiatrist, dentist, or veterinarian) by the United States Drug Enforcement Admin ...

or state license number); # by health plans in their internal provider files to process transactions and communicate with health care providers; # by health plans to coordinate benefits with other health plans; # by health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans; # by

electronic patient record An electronic health record (EHR) is the systematized collection of electronically stored patient and population health information in a digital format. These records can be shared across different health care settings. Records are shared thro ...

systems to identify treating health care providers in patient medical records; # by the

Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the US federal government created to protect the health of the US people and providing essential human services. Its motto is ...

to cross reference health care providers in fraud and abuse files and other program integrity files; # for any other lawful activity requiring individual identification.

Signup process

The NPI number can be obtained online through the National Plan and Provider Enumeration System (NPPES) pages on CMS's website. Turnaround time for obtaining a number is from 1 to 20 days. NPI numbers can be searched on the CMS website listed in external links 'National Plan and Provider Enumeration System information from CMS'.

Identifier details

The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. As outlined in the federal regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes. Ten-digit NPI numbers may be validated using the

Luhn algorithm The Luhn algorithm or Luhn formula (creator: IBM scientist Hans Peter Luhn), also known as the " modulus 10" or "mod 10" algorithm, is a simple check digit formula used to validate a variety of identification numbers. The algorithm is in the pub ...

by prefixing "80840" to the 10-digit number.

Open data set

NPI data is downloadable from CMS. The downloadable database was updated monthly until December 2012, and has been issued weekly since. A data structure file is available separately from CMS. As of June 2024, the file download size is 947.84 MB, and the raw database file (npidata_pfile_20050523-20240512.csv) is 9.3 GB when extracted. The size of the data has been steadily growing over time. The size of the raw database file was 8.8GB in June 2023, and 8.2GB in June 2022.

Use as a data key

The NPI is a data key that identifies a substantial portion of healthcare providers and other entities in the US, it is a frequently used data key in other data sources. For instance, the DocGraph data set is a crowdfunded

open data Open data are data that are openly accessible, exploitable, editable and shareable by anyone for any purpose. Open data are generally licensed under an open license. The goals of the open data movement are similar to those of other "open(-so ...

set that details how healthcare providers collaborate to deliver care (i.e. referral patterns) that uses the NPI as its data key. The NPI is often a common denominator between various healthcare provider identifier numbers, such as CMS Certification Number (CCN; formerly OSCAR number),

Employer Identification Number The Employer Identification Number (EIN), also known as the Federal Employer Identification Number (FEIN) or the Federal Tax Identification Number (FTIN), is a unique nine-digit number assigned by the Internal Revenue Service (IRS) to business enti ...

, and PECOS Associate Control ID (PAC ID). With an increasing number of publicly available datasets containing these identifiers, some organizations have extracted the most plausible links between these identifiers. For example, a crosswalk between CCN and NPI can be obtained by analyzing the facility ownership datasets. As another example, a subset of the crosswalk between EIN and NPI can be derived by analyzing the provider reference files from various payers.

Notes

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External links

Official NPI Registry Search

National Provider Identifier Standard

NPI Lookup
Medicare and Medicaid (United States) Identifiers 2006 establishments in the United States