What is an NPI Number?

Every time your doctor’s office or hospital bills your insurance company, it transmits electronic information about your health. As a result, the Federal Health Insurance Portability and Accountability Act, or HIPAA, requires you to have a National Provider Identifier, or NPI, number. Healthcare providers must identify themselves with this 10-digit marker when they electronically submit information about patient conditions, diagnosis, and treatments.

When the number is used

Your provider must submit the NPI number each time they make and report a HIPAA transaction. These events include examination and treatment of patients; submitting and verifying applications for insurance benefits, patient referrals, and prior certification or prior approval of services.

Mandatory users

In addition to doctors, dentists, pharmacists, nurses, chiropractors, physical therapists, nursing homes, ambulance companies, and medical device providers are among the providers who must carry an NPI number. Those who provide services, such as non-emergency ambulance transportation, housekeeping, and the installation of guardrails or ramps to accommodate people with disabilities, are not considered health care providers and do not receive an NPI number. .

Doctor or number lookup

The National Plan and System Provider Enumeration maintains a database for you to find the provider’s NPI number or provider identity. The NPI registry will give you, in addition to the NPI, the provider’s address, type of service or general area of ​​practice, and the insurers accepted by the provider.

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