National Provider Identifier Number

Whether you’ve been practicing physical therapy or how new you are, getting your NPI number should be a top priority.

Providers who meet the broad definition of a “covered entity” defined by the HIPAA must use this 10-digit number when submitting claims to payers. All Medicare providers must also have an NPI. The NPI replaces any legacy or billing number in private and public health insurance plans.

NPIs: Who can get it

how to get National Provider Identifier Number

Health care providers must acquire NPIs, whether individuals or organizations, that HIPAA covers must obtain an NPI. The term “covered entity” refers to any entity that transmits health information in electronic forms, such as when filing a claim. Examples include:

  • Health care providers conduct electronic transactions.
  • A clearinghouse for health care information.
  • Health insurance (including commercial plans, Medicare, and Medicaid).

You are considered a “covered entity” even if you use a business associate to transmit health information electronically with a HIPAA standard transaction.

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Categories of NPI

Type 1 (Individuals)

Type 2 (Organizations)

A physical therapist, a nurse,  a physician, a chiropractor, a dentist,  and a pharmacist fall under Type 1. 

Hospitals, nursing homes, laboratories, pharmacies, ambulance companies, and residential treatment centers are type 2 entities. 

Clinics, group practices, health maintenance organizations, and home health agencies are type 2.

Physical therapists in group practices, as well as in individual practices, must obtain an NPI.

An NPI should be assigned to both the corporation and the individual therapist in solo incorporated practices. You must apply for each NPI separately. On the individual application, you should include your state’s physical therapy license number. In contrast, you should include the tax identification number assigned to the corporation on the corporate application. Your state license number is not required when applying for a corporate NPI.

NPIs are available to all health care providers, even if you are billed by a facility rather than individually. You may be asked for your NPI by nursing homes and hospitals. They are not required for health care providers who are not “covered entities,” but we encourage all PTs and PTAs to have one.

Applying for NPI

National Provider Identifier

An NPI number can be applied via regular mail, CMS’s web-based application process, or a file interchange system.

It’s most efficient to use CMS’ web-based application. To learn more, visit CMS’ website on applying for an NPI number. There is a link to the NPPES at the bottom of the webpage. The application takes less than 30 minutes once you have gathered the required documents, including your social security number and state license information. Allow a day for mailing and processing.

Enrollment in Medicare and NPI

NPI

Medicare enrollment requires an NPI. Otherwise, you will be unable to enroll. Make sure the information on your Medicare enrollment form matches the information in your NPI application. CMS may reject your claims if there is a difference between your applications. NPI profiles can be easily updated online.

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