How does the NPI registry work?
NPPES NPI Registry
You can search for providers in the NPPES (National Plan and Provider Enumeration System) system using the NPI (National Provider Identifier) Registry. The NPI Registry distributes all of its data in compliance with the NPPES Data Dissemination Notice. The NPI Registry is completely free to use.
National Provider Identifier Standard (NPI)
The National Provider Identifier (NPI lookup tool) is an Administrative Simplification Standard under the Health Insurance Portability and Accountability Act (HIPAA). For covered health care providers, the NPI is a unique identifying number. In the administrative and financial activities required by HIPAA, covered health care providers, all health plans, and health care clearinghouses must use NPIs.
The NPI is a ten-position (10-digit number) numeric identification that is lacking intelligence. This means that the data don’t contain any further information about healthcare providers, such as where they live or what medical specialty they practice.
In HIPAA standards transactions, the NPI must be used instead of traditional provider identification.
Benefits of an NPI
- HIPAA standard transactions can be easily transmitted electronically.
- For health care providers, health care plans, and employers, standard unique health identities are required.
- Efficient coordination of benefit transactions.
How Do You Find an NPI?
The National Plan and Provider Enumeration System (NPPES) assigns NPIs, maintains and updates information about health care providers with NPIs, and disseminates the NPI Registry and NPPES Downloadable File.
Who May Get an NPI?
An NPI can be obtained by any health care professional (physicians, suppliers, hospitals, and others). Individuals or organizations that offer health care are defined as health care providers in 45 Code of Federal Regulations (CFR) 160.103.
Who May Not Get an NPI?
Any entity that does not match the 45 CFR 160.103 definition of a health care provider is not eligible to apply for an NPI. Billing services, value-added networks, repricers, health plans, health care clearinghouses, non-emergency transportation services, and others are examples of such organizations.