Fundamentals of Medicare

Section 1: Introduction


National Provider Identifier

The NPI is a HIPAA Administrative Simplification standard. The NPI is a unique identification number for covered health care providers that have replaced the legacy provider number.

Covered health care providers and all health plans and health care clearinghouses will use the NPI in the administrative and financial transactions adopted under HIPAA. The NPI is a ten-position, intelligence-free numeric identifier (ten-digit number). This means that the numbers do not carry other information about healthcare providers, e.g., 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.

If you are a health care provider who bills for services, you will need an NPI. If you bill Medicare for services, you definitely need an NPI! Getting an NPI is easy and free. If you delay applying for your NPI, you risk your cash flow and that of your health care partners as well.

As outlined in the federal regulation, HIPAA-covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.

More detailed information on NPI can be found on the CMS website.

Reviewed 6/4/2024