What is an NPI Number?

A National Provider Identifier (NPI) is a unique, 10-digit identification number issued to healthcare providers in the United States. The NPI was established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and is administered by the Centers for Medicare & Medicaid Services (CMS).

Why Do Healthcare Providers Need an NPI?

The NPI is used to identify healthcare providers in standard transactions, including:

• Filing claims with Medicare, Medicaid, and private insurers
• Checking claim status and eligibility
• Referrals and prior authorizations
• Electronic prescribing (e-prescribing)
• Coordination of benefits between insurers

Since May 23, 2007, all HIPAA-covered entities are required to use NPIs in electronic transactions.

Two Types of NPI

Key Facts About NPI Numbers

• An NPI is permanent - it stays with the provider for life, regardless of job or location changes
• A provider can have only one NPI (but organizations can have subparts)
• NPIs are free to obtain from NPPES
• NPIs do not carry information about the provider (they are "intelligence-free")
• NPIs replace prior identifiers like UPIN, Medicare PIN, and Medicaid provider numbers

Who Needs an NPI?

All healthcare providers who transmit health information electronically must have an NPI. This includes:

• Physicians (MD, DO)
• Dentists
• Nurse Practitioners and Physician Assistants
• Pharmacists and Pharmacies
• Hospitals and Clinics
• Durable Medical Equipment (DME) suppliers
• Home Health Agencies
• Physical, Occupational, and Speech Therapists
• Psychologists and Social Workers
• Chiropractors, Optometrists, Podiatrists

How to Look Up an NPI Number

You can look up any NPI number for free using our NPI lookup tool. Simply enter the NPI number, provider name, state, or phone number to find provider details including practice address, phone, fax, specialty, and Medicare PECOS enrollment status.