Update release    
July 16, 2017    
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About the National Provider Identifier (NPI)

 

The purpose of the National Provider Identifier (NPI) program is to assign a unique national identification code to all providers of health care whose services fall under HIPAA, including individuals, organizations and groups of individuals. Included are physicians, nurses, nurse practitioners, dentists, optometrists, pharmacists, physical therapists, pharmacists, physician group practices, acute care hospitals, specialty hospitals, nursing homes, ambulatory care facilities, hospices, home health agencies, ambulance services, clinical labs, DME suppliers, pharmacies, etc. The number would be used in standard transactions by all health plans eliminating the current system of multiple numbers for a single provider. (Take a look at included healthcare providers.)

The NPI Final rule requiring providers to be included in the data, and to update within 30 days of any change.

A work group consisting of representatives from the private sector, Federal and State agencies came together in 1993 to define the NPI and establish a system for assigning the numbers to every U.S. HIPAA-covered entity. They developed the National Plan and Provider Enumerations System (NPPES) to operate as the central database for the NPI. While the word "Plan" in the system's name would imply that health plans are also included in the data, this extension of the system has not yet materialized.

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. It replaces a fragmented system of identifiers that included UPINs, Medicare PINs, state Medicaid numbers, provider identifiers assigned by thousands of health plans, and other identifiers—all of which were needed to disambiguate a particular provider across the healthcare system. The NPI is a unique identification number intended to solve this problem. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions.

As outlined in the Federal Regulation, The Health Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

Providers must apply for their NPI number (a process called "enumeration"), which is generally accomplished using an online tool provided by the Centers for Medicare and Medicaid Services (CMS), a division of the U.S. Department of Health and Human Services (HHS). Information supplied by the provider is kept in the National Plan and Provider Enumeration System (NPPES) database. Information includes in-depth contact information, specifics regarding the provider's practice or facility, and other identifying codes such as Medicare and Medicaid identification numbers and the deprecated UPIN.

Providers may choose to use a written form that can be submitted by mail. Download the NPI enumeration form to review the kinds of information collected in the NPPES database.

The NPPES database does not include a provider's PECOS status (enrollment to bill Medicare), or whether or not the provider is on the federal List of Excluded Individuals/Entities (LEIE) from the HHS Office of Inspector General (OIG); however, CarePrecise compiles this information into the CarePrecise Access and CarePrecise Select database products. The NPPES database, as released by CMS, is of a size and format that is not ready for use on ordinary computers in standard office software, such as Microsoft Office® products; CarePrecise makes the complete NPPES data, along with added information from PECOS, LEIE and other sources, available for such use.

Questions About the NPI

CMS provides an NPI search tool for looking up providers' NPI numbers.

CarePrecise provides a listing of the data fields from the NPPES that are included in CarePrecise healthcare provider data products.

NPI Statistics

Healthcare Provider Statistics

Release: 6/19/2017
Total NPI Records: 5,142,094
Provider Records Added Since Last Month: 31,421
Records Retired Since Last Month: 1,581
Excluded Providers (barred from Medicare): 4,023
Providers in PECOS (enrolled to bill Medicare): 1,335,515
Single/Multi-specialty Practice Groups: 599,999
Providers Who Changed Records Last 60 Days: 92,792

Obtaining the NPI Database

Review CarePrecise Access Complete for the full NPI database, with added data from related federal healthcare provider databases.

CarePrecise Gold offers the complete database, plus special tools for segmenting providers by specialty, geographic radius, wealth, urban/rural, and other parameters.

Complete NPI data can be obtained for individual states; see CarePrecise Access State.

 

Additional Resources

Refer to the CMS field descriptions for technical descriptions of the data fields. CarePrecise uses abbreviated field names.

Refer to the CMS field codes document for details on field codes used in CarePrecise.

Access Complete - Full U.S. healthcare provider database, updated monthly.

Access State - State by state healthcare provider data, updated monthly.

Select Hygiene - Service that provides enriched data for clients' in-house databases.

Select Targeted - Permits clients to select specific provider specialties and facilities in particular geographic areas, and many other selection criteria.

CP ListMaker - Desktop application that allows clients to create highly targeted lists of providers for industry research, clinical trial development and marketing applications, using the Access Complete data. It is also available bundled with the data.

Wikipedia NPI page.


 

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