Why, When, and How to Get an NPI Number

Wellness professionals constantly deal with codes and identifiers for regulatory, billing, and administrative purposes. So, you’d be forgiven if it feels daunting to add another number to the list in the form of a National Provider Identifier (NPI). However, it’s important to understand the significance of the NPI number, especially as your practice grows.

If you’re unfamiliar with NPI numbers, you likely have questions about who needs an NPI number, how to get an NPI number, how long it takes to get an NPI number, and more. This article covers everything you need to know about NPI numbers — from what they are to how they relate to HIPAA to the different methods you can use to get one of your own. Keep reading to boost your National Provider Identifier IQ!

What is an NPI number?

The Centers for Medicare & Medicaid Services (CMS) introduced the National Provider Identifier system in the United States in the late 2000s. The intent was to standardize the identification of healthcare providers across various systems, while improving the accuracy and efficiency of electronic transactions in the industry.

• NPI numbers are 10-digit numerical identifiers assigned to healthcare service providers in the United States – both individuals and organizations. (Stay tuned: There’s more to come on that distinction later in this post!)  

• Each assigned NPI number is unique and permanent. Even if a practitioner changes jobs or locations, their NPI number will always remain the same. 

• An NPI number doesn’t include any personal information about the individual it is assigned to, like the services provided or the practice location.

What is the purpose of an NPI number?

NPI numbers accurately identify care providers during electronic transactions, billing, and claims processing. They have an interdependent relationship with HIPAA (Health Insurance Portability and Accountability Act).

NPI numbers serve as unique identifiers to help with accurate data exchange and billing processes. HIPAA sets the standards for safeguarding patient information and ensuring the privacy and security of sensitive health data, including information related to NPIs. As a health and wellness professional you need to navigate both NPI usage and HIPAA compliance to maintain the integrity of client care and data protection.

Here is an example of where to enter your NPI number in the Practice Better portal:

Storing your NPI number in the Practice Better portal under Settings > All Settings and Preferences > Insurance Billing ensures your NPI number is automatically included in CMS 1500 forms, saving you precious time on tedious paperwork.

According to CMS, there are three main benefits associated with having an NPI number:

• They simplify electronic transmission of HIPAA standard transactions.
• They provide standard unique health identifiers for healthcare providers, healthcare plans, and employers.
• They allow for efficient coordination of benefit transactions.

Who needs an NPI number?

NPI numbers are available to providers involved in patient care and engaged in electronic transactions related to healthcare services. You can get an NPI number if you provide care as defined in 45 Code of Federal Regulations (CFR) 160.103.  Here are a few guidelines to keep top of mind:

• You must get an NPI number if you’re a HIPAA-covered entity. Basically, if you are transmitting patient health information in electronic form in connection with a HIPAA standard transaction then you need an NPI number. 
• You must have an NPI number prior to enrolling with Medicare. 
• Practitioners who hold a license to provide healthcare services are likely to need an NPI number. Those offering mental health services, such as counseling, psychotherapy, and behavioral therapy, are often required to have one too. 
• Wellness practitioners offering alternative or complementary therapies may also need an NPI number, depending on state regulations and their scope of practice.

If you’re unsure whether you need an NPI number, you can research your specific state and industry regulations to help you determine the answer.

To contextualize this, imagine you operate a naturopathic clinic offering a range of services delivered by licensed professionals, including acupuncture, herbal medicine, nutritional counseling, and wellness workshops. From an administrative perspective, treating each of these as subparts allows you to track services, bill accurately, and provide a seamless experience to your clients. In this case, each subpart would need its own unique NPI to make for easier electronic transactions and accurate record keeping.

Can you apply for NPI number without a license?

Yes, you can apply for an NPI number without having a professional license. The NPI system was designed to create a standardized identifier for accurate data exchange, coordination of benefits, claims processing, and billing. Not all individuals involved in those activities are licensed providers.

How to obtain an NPI number

Three are three ways to apply for an NPI number: online, by mail, or through a third party.

1. Apply online - You can apply for an NPI number through the National Plan and Provider Enumeration System (NPPES) website.

• You need an Identity & Access (I&A) User ID to complete the NPI application. You get this by choosing the “Create or Manage An Account” option on the NPPES home page.

• You will see a pop-up informing you that you’re being redirected to the I&A website.

• Click OK and then follow the prompts on the I&A website to complete your registration for a User ID and Password.
• Now you can return to the NPPES homepage and log in with your new User ID and Password.

• Once you’ve successfully signed in, you can select whether you are submitting a new NPI Application for yourself (Type 1), another individual (Type 1), or an organization (Type 2).
• Note that you don’t have to complete an application all in one sitting. The website allows you to save your progress and return to the application at a later date. 
• Once you reach the end and pass the system error check you must certify that the information in your application is correct and complete. At this point you’ll receive a submission confirmation with a tracking number. You’ll also receive a confirmation email at the contact email address you supplied in your application.

The above summary only covers the high-level steps involved. If you’d like a more comprehensive step-by-step walkthrough of how to apply for an NPI number online, CMS provides one over here.

2. Apply through the mail - You can download and print off a paper application from the CMS website. Complete the application, sign, and mail it to the NPI Enumerator address listed on the form.

If you’d like to request a hard copy application rather than printing off your own, you can do so through the NPI Enumerator, call 800-465-3203 or TTY 800-692-2326, or send an email to [email protected].

3. Apply through a third party - This option is beneficial if many providers are applying for NPI numbers. You can give permission to an Electronic File Interchange Organization (EFIO) to send application data on your behalf.

PS: If you’re wondering about the NPI number application cost, note that applying for an NPI number through the official NPPES website is free.

How long does it take to get an NPI number?

You should receive your NPI number within 15 days, although in some cases it may come through even faster. If the NPPES needs to conduct additional data verification, it can take up to 30 days to get an NPI number.

Your submission confirmation page will provide you with contact information if you need to follow up on your application. 

Where do you go from here?

NPI numbers aren’t just helpful for regulatory agencies. They’re also a valuable tool for wellness professionals to promote easier information exchange, more accurate billing, and smoother continuity of care between referral partners. Even if you don’t currently offer insurance-covered services, applying for an NPI number can help to future-proof your practice as it grows.

Now that you’ve read this article you should have a good sense of the steps you need to take to get an NPI number – for yourself or your organization. If you still have questions around how to get an NPI number, or anything else NPI-related, check out the comprehensive list of frequently asked NPI questions.

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