National Provider Identifier FAQs

Q: Who is eligible to receive an NPI?
A: Health care providers including hospitals, nursing homes, durable medical equipment suppliers, clinical laboratories, pharmacies and many other "institutional" type providers; physicians, dentists, pharmacists, nurses, registered dietitians and many other health care practitioners and professionals; group practices, health maintenance organizations and others.

Q: Will a health care provider continue to use other numbers besides the NPI to identify themselves in standard transactions after the compliance date?
A: Only the NPI may be used for identification purposes for a health care provider in standard transactions; legacy identifiers (such as the Unique Physician Identification Number (UPIN), Medicaid and Medicare Provider Number and others) may not be used. If a provider must be identified in standard transactions for tax purposes, they would use their Taxpayer Identifying Number.

Q: Do I need to obtain a National Provider Identifier (NPI) before enrolling or making a change to my Medicare enrollment information?
A: Yes. To apply for your NPI, you can complete the online application at NPPES.

Q: How long will it take to get an NPI?
A: CMS cannot predict the amount of time it will take to obtain a National Provider Identifier (NPI) because several factors come into play including the volume of applications being processed at a given time, whether the application was submitted electronically or on paper, and whether the application was complete and passed all edits. CMS expects that a health care provider who submits a properly completed electronic application could have an NPI in 10 days or less.

Q: If a health care provider with an NPI moves to a new location, must the health care provider notify the enumerator (Fox Systems, Inc.) of their new address?
A: A covered health care provider must notify the enumerator of changes in any of the information furnished on their application for a National Provider Identifier (NPI), and must do so within 30 days of the change. The enumerator is responsible for dealing with providers on all issues relating to the NPI.

In addition to notifying the enumerator, provider must also inform CMS of any changes. CMS has established Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for physicians, non-physician practitioners and providers and suppliers organizations for this reason. Internet-based PECOS allows physicians, non-physician practitioners and provider and supplier organizations to enroll, make a change in their Medicare enrollment, view their Medicare enrollment information on file with Medicare, or check on status of a Medicare enrollment application via the Internet. Visit PECOS to access this feature.

Q: Is the NPI form still downloadable from the CMS and NPI enumerator websites?
A: This form is available for download from the CMS website or by request from the NPI Enumerator. Providers who want to submit their application electronically can fill out the application on the CMS website and submit it online. Print a copy for your files before sending to CMS.

Q: Do I need my own NPI number even if I work in a hospital with its own NPI?
A: Yes. According to an official at Fox Systems, Inc., the NPI has nothing to do with where you work. The NPI is a personal identification number. "That way you have the ability to work where you want to work and the NPI will follow," said the official. In addition, there will often be two NPIs on claims transaction: one NPI for the place where the service was rendered and one NPI for provider who provided the service.

Q: If I work at two practice locations (i.e. a clinic and at my own private practice), do I need to get two NPIs?
A: No. Your individual NPI follows you everywhere. However, if you’ve reassigned your benefits to the clinic, their group NPI will be sufficient on any HIPAA compliant claims submitted for your services. If you've not reassigned your benefits to the clinic, your individual NPI should appear on any HIPAA transaction. In addition, your individual NPI can be used at your own practice when you make HIPAA compliant transactions.

Q: Will my NPI deactivate if I don't use it after 12 months?
A: No. The NPI doesn't automatically deactivate. If you no longer need or require an NPI you must deactivate it yourself by calling the NPI enumerator at 800/465-3203.