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National Provider Identifier

Compliance Date for National Provider Identifier is May 23, 2007

Healthcare providers, including physicians, dentists and pharmacists, must soon use a National Provider Identifier (NPI) when conducting standard electronic transactions, even if they use billing agencies to prepare them. These transactions include claims, eligibility and claims inquiries and responses, referrals and remittance advices.

This identifier implements a HIPAA requirement and must be used by most HIPAA-covered entities, which includes health plans, healthcare clearinghouses and healthcare providers that conduct electronic transactions. The NPI will replace healthcare provider identifiers in use today in standard transactions and eliminates the need for providers to use different identification numbers to identify themselves when conducting standard transactions with multiple health plans.

Many health plans, including Medicare, Medicaid, private insurers and all healthcare clearinghouses, must use NPIs in standard transactions by May 23, 2007. Small health plans have until May 23, 2008. After those compliance dates, physicians and other healthcare providers may use only their NPIs to identify themselves in standard transactions.

Once enumerated, a provider's NPI will not change and remains with the provider regardless of job or location changes.

To obtain an NPI, click here to complete an application online. You can also obtain a written application by calling 1-800-465-3203.