NPI: Get It. Share It. Use It.
February 1, 2007
Enumeration Advice for Incorporated Individual Providers
Health care providers who are individual proprietors are
eligible for an Entity Type 1 (Individual) National Provider
Identifier (NPI). When such individual providers incorporate
themselves (form corporations), and these corporations are
health care providers, then the corporations are organization
providers eligible for an Entity Type 2 (Organization) NPI. If
either of these health care provider entities (the individual or
the corporation) are covered providers under HIPAA (for example,
providers sending electronic transactions), the NPI Final Rule
requires them to obtain NPIs.
Common Testing Error Identified
Two common errors have been discovered in recent claim
submission testing:
- Submitters incorrectly indicate an NPI in the 2010AA Billing Provider REF02 segment instead of the NM109 segment. The claim submitter must submit an NPI in the NM109 segment.
- Submitters incorrectly indicate a “legacy identifier" in the NM109 segment. The REF02 is “situational” but required if necessary to report a secondary ID, for example a “legacy identifier” or a taxpayer ID number.
To aid in crosswalk development during testing, please remember to correctly designate the type of identifier you are submitting.
Resources for Commonly Asked Questions
To view a list of resources that will help answer many questions
about NPI, visit the NPI area of the
CMS Web site and click “NPI Question Resources.” CMS
also continues to update the frequently asked questions about
NPI, which can be viewed by clicking “ Educational Resources,”
then “Frequently Asked Questions.”
The National Plan and Provider Enumeration System (NPPES) support desk can answer or address only these types of questions/issues:
- Status of an application
- Forgotten/Lost NPI
- Lost NPI notification letter (for example, those providers who received their NPIs via paper or web-based applications)
- Trouble accessing NPPES
- Forgotten password/User ID
- Request for a paper application
- Clarification on information in the NPI application
For assistance with the issues above, please contact NPPES at 1-800-465-3203. TTY users (text telephone) can call 1-800-692-2326. You can e-mail a request to CustomerService@NPIenumerator.com.
Note: |
The NPPES’ operation is closed on the following observed federal holidays: New Year's Day, Martin Luther King, Jr. Day, Washington’s Birthday, Memorial Day, Independence Day, Labor Day, Columbus Day, Veteran’s Day, Thanksgiving Day and Christmas Day. |