Information on a Physician NPI Number

A physician NPI number (National Provider Identifier) is a unique,10-digit number assigned to individual health care providers. Providers must use this number with health insurance plans and health care clearinghouses for billing purposes, according to the Centers for Medicare and Medicaid Services, the government agency that oversees the NPI. Physician NPIs help simplify administrative and financial transactions associated with doctor and hospital visits, diagnostic tests, procedures and treatments.

Purpose

• Physician NPI numbers uniquely identify health care providers without revealing any personal data. NPIs help identify doctors on hospital bills, prescription information, patient medical records, insurance claims or any other documents transmitted by a health plan, health agency or processing organization.

History

• The Centers for Medicare and Medicaid Services website notes that before Congress mandated a standardized NPI, health care providers had multiple identification numbers for each health plan or health agency, such as Medicare or Medicaid.

  In 1996, Congress enacted the Health Insurance Portability and Accountability Act (HIPAA), which provided privacy protection for consumers. The NPI mandate was part of this law, thereby standardizing health care transactions and protecting provider privacy, as well.

Registry

• The U.S. Department of Health and Human Services maintains a searchable registry of approved health care providers, sorted by NPI. The registry provides only the provider's name, office address, office telephone number, primary medical specialty and type of provider, so that health plans, hospitals or state health agencies may verify NPI information for billing purposes.