Nurse Practitioner NPI

What is a NPI and How Do You Get One?

If you’ve just graduated from your nurse practitioner program, you are likely overwhelmed by the number of licenses and certifications NPs are required to obtain. There’s a DEA number if you plan to prescribe controlled substances, a state NP license, and a national certification. In addition, all healthcare providers, nurse practitioners included, must apply for a National Provider Identifier (NPI). So, what exactly is a NPI, why do you need it, and how do you get one?

What is a National Provider Identifier?

A National Provider Identifier, commonly known as NPI, is a unique 10 digit identification number given to healthcare providers by the Centers for Medicare and Medicaid Services (CMS). In this case, healthcare providers include individuals, groups, or organizations that provide medical or other health services or supplies. The NPI was established as part of the 1996 Health Insurance Portability and Accountability Act (HIPAA) that required the adoption of a standard, unique identifier for healthcare professionals. While the identifier was mandated by the 1996 law, NPIs were not issued until 2006.

All healthcare providers or organizations covered by HIPAA, from physicians and nurse practitioners to social workers and home health agencies must obtain a NPI. Health industry workers such as medical billing personnel or hospital housekeeping staff who do not provide direct healthcare are not required to have a NPI. A provider’s NPI does not change and stays with the provider regardless of job or location changes.

What is a NPI used for?

Before the NPI, there was no standard method for identifying healthcare providers. This lack of coordination was confusing and inefficient. So, the NPI was introduced.

The NPI is used by healthcare providers to identify themselves and other healthcare providers in healthcare transactions or correspondence. It may be used by pharmacies to identify providers on prescriptions (the NPI does not replace a DEA number). Insurance companies and health plans also use the NPI to process claims. Finally, the NPI is used by electronic medical record systems to identify providers in patient records.

Is my NPI confidential?

A provider’s NPI is not confidential. An online NPI Registry allows anyone to look up a provider’s NPI at any time. The registry lists the provider’s NPI as well as other information such as practice address and licensing information.

How do nurse practitioners apply for a NPI?

To apply for a NPI, visit the National Plan and Provider Enumeration System (NPPES) website and create a login. You will need your licensing information, so have your state RN and APRN license handy. The process is free and easy.