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NPI: Applying for NPI (with NPPES)

This article provides information on how to obtain an NPI from the National Plan and Provider Enumeration System (NPPES). Providers may now begin requesting NPIs through NPPES through the application options explained in this article.

How Does a Provider Get an NPI?

Covered health care providers can obtain an NPI through one of three options. Application is the process of requesting and receiving an NPI. The three application options are: 1) paper application, 2) Web application and 3) electronic file interchange (EFI).

  1. Paper application – The paper application is available at the Centers for Medicare & Medicaid Services Web site and through the mail from the NPI Enumerator. The Enumerator is a contractor hired by the CMS to facilitate the assignment of NPIs to health care providers. The application should be completed, signed and mailed back to the Enumerator (retain a copy for your records). The key application data elements are as follows:
    • Provider name
    • Other name used (if applicable)
    • Practice location, address and phone number
    • Mailing address and phone number
    • Social Security Number (or alternative proof of identity for individuals)
    • Employer Identification Number (for organizations)
    • Date, state, country of birth and gender (for individuals)
    • Taxonomy
    • License number and state
    • Other provider identifiers used
    • Authorized official (for organizations)
    • Contact information

    CMS estimates that the processing time for paper applications will be approximately 20 calendar days.
    For a paper application, call the Enumerator at 1-800-465-3203 (hearing impaired users can call the TTY/TDD line at 1-800-692-2326).

    Note: CMS has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. NPPES collects identifying information on health care providers and assigns each a unique National Provider Identifier (NPI).

  2. Web application – Health care providers can register for an NPI through direct data entry in the NPPES Web site. To enter data, the provider must obtain a user ID and password from the NPPES. The Web application has similar data element requirements to the paper application. The resulting NPIs from Web applications will be e-mailed to the designated contact person within five calendar days. The NPPES Web site is now available for direct data entry registration of an NPI.

  3. EFI bulk enumeration – The NPPES allows approved EFI filing organizations to submit multiple applications in one batch file instead of single paper or Web applications. The EFI filing organization must obtain authorization from each provider and must certify the accuracy of the data. After the NPIs are issued, the EFI filing organization will be responsible for distributing the NPIs to providers. Information on EFI bulk enumeration is available at https://nppes.cms.hhs.gov/NPPES/EFIHome.do.

    The NPI rule designates two categories of health care providers for the enumerating process:

    • Entity Type Code 1 – Will be issued to health care providers who are individual human beings (i.e., physicians, nurses, dentists, chiropractors, pharmacists and physical therapists). Entity Type Code 1 NPIs are considered a permanent designation unless circumstances justify deactivation.
    • Entity Type Code 2 – Will be issued to organizations (i.e., hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, HMOs, Durable Medical Equipment suppliers and pharmacies). Entity Type Code 2 NPIs are considered a permanent designation unless circumstances justify deactivation. A new NPI is generally not required for a change of ownership, legal formation, location, address, taxonomy, name, employer identification number, state of licensure or state license number. These types of changes are submitted to the NPPES and the information is updated for the assigned NPI.

Important NPI Reminders

  • As of the NPI compliance date (May 23, 2007 for providers, clearinghouses and large health plans), the NPI is the only provider identifier that will be allowed within HIPAA transactions.

    For important NPI time frame changes, check the NPI Overview page.
  • The NPPES is the CMS-sponsored system that will serve as the data repository for NPI-related information. The NPPES will be used to process new applications, updates and generate NPIs.
  • The NPI Enumerator is a CMS-contracted vendor that will perform provider registration and enumeration processing using the NPPES. The Enumerator enters data from paper applications, resolves problems and answers questions related to the NPI and the registration process. Once the data processing is completed, the Enumerator will notify providers of their assigned NPI.
  • Providers must continue using their existing provider numbers for all Medi-Cal transactions until further notice.