National Provider Identifier (NPI)
A National Provider Identifier (NPI) is a 10-digit numerical unique identifier and a Health Insurance Portability and Accountability Act (HIPAA) standard. NPI replaced the numerous different provider numbers previously issued by each payer with a single identifier that is used across all health plans.
There are 2 different types of NPIs; Type 1 (individual) and Type 2 (organizational).
All clinical providers need to obtain a type 1 (individual) NPI number. This number will identify the provider who rendered services to a patient and needs to be reported on claim forms sent to payers.
Group practices that bill with a group tax identification number (TIN) should also apply for a Type 2, organizational NPI. This Type 2 NPI number should be used to complete enrollments with payers and for billing purposes. For group practices, individual providers' NPIs will be linked to the group NPI in the payer's system and both reported on claim forms submitted for reimbursement.
1500 Claim Form - Professional Claims
- Box 24J - rendering provider NPI number
- Box 33A - individual (type 1) NPI number for sole practitioners or organizational (type 2) NPI number for practice groups
UB04 Claim Form - Institutional Claims
- Box 56 - NPI of the billing provider (could be individual or organizational)
- Box 76 - Attending provider NPI (individual NPI)
- Box 77 - Operating provider NPI (individual NPI)
- Box 78 - Other provider NPI (individual NPI)
- Box 79 - Other provider NPI (individual NPI)
