The NPI is a unique identification number for health care providers. Health care providers, health plans and health care clearinghouses use NPIs in the administrative and financial transactions specified by HIPAA. The NPI is a 10-position numeric identifier with a check digit in the last position to help detect invalid NPIs. The NPI contains no embedded intelligence; that is, it contains no information about the health care provider such as the type of health care provider or state where the health care provider is located.

There are two Health Affairs (HA) Policies and one HA Guideline that describe the types of providers in the MHS that require NPIs. These include: HA Policy 05-002 (NPI Enumeration of MHS Individual (Type 1) Health Care Providers), HA Policy 05-012 (NPI Enumeration of MHS Organizational (Type 2) Health Care Providers) and HA Guideline dated May 2007. According to these policies and guideline the following MHS providers are required to obtain and use an NPI: 

Individual (Type 1) Health Care Providers

Providers who furnish billable services or those that may initiate and/or receive referrals. In the MHS, this affects the following types of providers: All privileged providers, residents, and certain non-privileged providers such as Independent Duty Corpsmen who request referrals, Independent Duty Medical Technicians working in the cast clinic, or a nurse giving Depo-Provera injections when the patient has not seen the physician. These provider types need to be identified with an NPI in certain HIPAA electronic transactions.

Organizational (Type 2) Health Care Providers

• Military Treatment Facilities (MTFs) with legislative authority to bill, including Defense Health Program (DHP) funded facilities and air evacuation facilities
• MTFs that generate ambulatory data records, third party bills, Standard Inpatient Data Records and Standard Ambulatory Data Records
• MTF pharmacy dispensing locations that currently have an NCPDP provider identification number
• MTFs that generate or perform referrals
• MTFs that provide health care services

MHS providers have been required to obtain and use the NPI since 2007.

Health care providers can obtain NPIs by submitting an application to the National Plan and Provider Enumeration System (NPPES). The NPPES was developed by the Centers for Medicare and Medicaid Services (CMS) to process NPI applications. Providers have two options when applying for their NPIs:

• Through a web-based application 
• Through a paper application. You can download the paper application, which includes the Enumerator's mailing address. Or, call the Enumerator for a copy at 1-800-465-3203 or TTY 1-800-692-2326.

After an application is successfully processed, health care providers will be notified of their NPIs. HHS has contracted with an organization, known as the enumerator, to process NPI applications. In addition to receiving and processing NPI applications and notifying health care providers of their NPIs, the enumerator uses the NPPES to perform the following functions: ensure the unique identification of a health care provider; answer questions about the processes of applying for and obtaining NPIs and furnishing updates; collect information via the applications and updates, maintain the NPPES database containing NPIs and information about the health care providers to which they are assigned; and furnish information upon request and in accordance with established guidelines.

Ensure the MHS has your National Provider Identifier (NPI) on file. MHS providers who furnish billable health care services, write prescriptions, initiate and/or receive referrals should have obtained, submitted and began using an NPI effective May 2007. This includes all privileged providers, residents, and certain non-privileged providers. Non-privileged providers are required to obtain an NPI if they request referrals, request consults, write prescriptions or provide billable services. For example, Independent Duty Corpsmen who request referrals, Independent Duty Medical Technicians working in the cast clinic or a nurse giving Depo-Provera injections when the patient has not seen the physician would need to be identified in certain HIPAA electronic transactions.

1. Active Duty providers in any of the Services should submit their NPI to their Military Treatment Facility (MTF) Credentialing Office.
2. Army Reserve providers should submit their NPI to the Army Reserve Centralized Credentialing Affairs (ARCCA), excluding the Individual Mobilization Augmentee (IMA) who will turn it into their MTF of assignment.
3. Army National Guard providers should submit their NPI into the State Surgeons Office where their credentialing office is located.
4. Navy Reserve Independent Practitioners should provide their NPI during the normal privileging application process. The Centralized Credentials and Privileging Department, NHSO Jacksonville began collecting NPIs effective June 15, 2005.
5. Air Force Reserve and Guard providers should submit a copy of their NPI letter to their local reserve or guard unit Credentials Manager.

Once an MHS provider has an NPI, these offices will forward a copy of the NPI letter to the appropriate support office for entry of the NPI information into the Defense Manpower Human Resource System internet (DMHRSi), which is the MHS repository for the NPI. If you are a new MHS provider, refer to the question, "How are NPIs issued?"

Due to the inconsistency between state licensure requirements for PAs, they are allowed to obtain an NPI without having to furnish a license number and/or state of license.

Yes, you have just one NPI for life; no matter where you are working or what specialty you are practicing.

The NPI is used as a means of communicating the identity of providers in HIPAA electronic transactions (e.g., billing and referral purposes) both within and external to the MHS. NPIs are also used for non-HIPAA purposes where a provider identifier is needed, such as on paper claim forms (e.g., CMS-1500 and UB-04 claims), referral forms and on prescriptions.

The NPI must be used to identify providers in standard electronic transactions identified by HIPAA. In addition, the NPI may be used in several other ways:

1. By health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;
2. By health care providers to identify other health care providers in health care transactions or on related correspondence;
3. By health care providers on prescriptions (however, the NPI could not replace requirements for the Drug Enforcement Administration number or State license number);
4. By health plans in their internal provider files to process transactions and communicate with health care providers;
5. By health plans to coordinate benefits with other health plans;
6. By health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;
7. By electronic patient record systems to identify treating health care providers in patient medical records;
8. By Health and Human Services (HHS) to cross reference health care providers in fraud and abuse files and other program integrity files;
9. For any other lawful activity requiring individual identification of health care providers, including activities related to the Debt Collection Improvement Act of 1996 and the Balanced Budget Act of 1997.

As of May 23, 2008, the NPI is the only identifier that can be used to identify a health care provider in standard transactions. Use of legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid Provider Number, Medicare Provider Number, and others) were discontinued on May 23, 2008. Where a health care provider must be identified in standard transactions for tax purposes, it would use its Taxpayer identification as required by the implementation specifications. Health care provider identifiers other than the NPI may continue to be used in the internal processes and files of health plans or health care clearinghouses if they wish to continue to use those identification numbers in those internal processes and files.

Yes, although the NPI Final Rule does not require that health care providers who are not covered entities under HIPAA obtain or use an NPI, the Rule also does not prohibit health plans from requiring their enrolled health care providers that are eligible for an NPI to obtain one.

Note: The NPI Final Rule does prohibit health plans from requiring a health care provider with an NPI to obtain additional NPIs.

While the NPI Final Rule does not require providers who do not conduct HIPAA electronic transactions to obtain an NPI, all eligible providers are encouraged to obtain an NPI. One reason is that the CMS-1500 and UB-04 paper claim forms were updated to accommodate the NPI and health plans have the option to require the NPI be used on these paper forms. Another reason for eligible providers to get an NPI is that there may still be other instances where providers who do not conduct HIPAA standard electronic transactions would need to be identified in standard transactions conducted by other providers. For example, a physician who writes a prescription (electronic or paper) but does not bill health plans directly is not required by the NPI Final Rule to obtain an NPI; however, there are transactions that will be generated after the prescription is written, and some of those are standard electronic transactions. The pharmacy that fills the prescription will most likely bill for the prescription claim electronically (a HIPAA standard electronic transaction). If the physician who wrote the prescription does not have an NPI, the pharmacy is left with the problem of how to identify the prescriber on this billing transaction.

The NPI is meant to be a lasting identifier, and does not change based on changes in a health care provider's name, address, ownership, membership in health plans, or Healthcare Provider Taxonomy classification. There may be situations where use of an NPI for fraudulent purposes results in a health care provider requesting a different NPI. Such situations will be investigated and a different NPI may be assigned to the requesting health care provider.

Health care providers are not required to renew their NPI once issued.

A covered health care provider must notify the enumerator of changes in any of the information that it furnished on its application for an NPI, and must do so within 30 days of the change. Health care providers who have been assigned NPIs, but are not covered entities, should do the same.