This category includes FAQs about providers that are required to apply for an NPI. The following types of questions/issues must be forwarded to NPPES at 1-800-465-3203, TTY 1-800-692-2326, or by e-mail at: CustomerService@NPIenumerator.com.

• Status of an NPI application, update or deactivation
• Forgotten/lost NPI
• Lost NPI notification letter
• Trouble accessing NPPES
• Forgotten password/User ID
• Need to request a paper application
• Need clarification on information that is to be supplied in the NPI application

For additional questions regarding NPI, contact the Telephone Service Center (TSC) at 1-800-541-5555, select language preference (option 11 for English; option 12 for Spanish), select option 16 from the main menu, then select option 18 from the submenu.

A. Individual Providers (Entity Type 1)
Examples of individual providers include physicians, nurses, psychologists, chiropractors, physical therapists, acupuncturists, speec therapists, pharmacists and others.

1. If an individual provider has two Medi-Cal provider numbers, can they obtain two NPIs?
   A: No. According to the NPI Final Rule, individual providers and sole proprietors are only eligible to obtain one NPI.
2. If a provider works at a hospital as a physician, a radiologist and a private practitioner, can the provider obtain more than one NPI even if they have two or more different occupations?
   A: No. According to the NPI Final Rule, individual providers or sole proprietors are only eligible to obtain one NPI.
3. Are Non-physician Medical Practitioners (NMPs) required to obtain an NPI?
   A: Yes. All HIPAA-covered health care providers must obtain an NPI for use to identify themselves in HIPAA-standard transactions.
4. Can an individual provider working in two or more different locations subpart?
   A: No. According to the NPI Final Rule, an individual provider or sole proprietor is only eligible for one NPI and may not subpart.
5. Does an individual with multiple provider numbers (i.e., HCB, RVN, EPS numbers) need to obtain an NPI for each of the provider numbers they possess?
   A: No. An individual provider or sole proprietor is only eligible for one NPI.
6. Do trainees or student interns need to obtain an NPI?
   A: Yes. According to the NPI Final Rule, trainees or student interns who have certification or a license to practice is a covered entity. Although Medi-Cal does not enroll trainees or student interns, they are still required to obtain an NPI. Effective December 17, 2007, Department of Health Care Services will only accept either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise.
7. Would a situation occur where an individual provider has two NPIs (one for the provider and one for the corporation or group)?
   A: Yes. According to CMS, health care providers who are individuals are eligible for an “Entity Type 1” (Individual) NPI. If these individuals incorporate and form a corporation and the corporation is also a health care provider, the corporation is considered an organization, which is eligible for an “Entity Type 2“ (Organization) NPI. If either of these health care providers (the individual or the corporation) are covered providers (i.e., providers that send electronic transactions) under HIPAA, the NPI final rule requires them to obtain NPIs. In addition to electronic transactions, Medi-Cal is also requiring an NPI on all paper claims.
8. Can an individual provider that provides services for special programs such as Family PACT and the Cancer Detection Program: Every Woman Counts (CDP: EWC) obtain multiple NPIs in order to receive separate RADs or warrants?
   A: No. Individual providers and sole proprietors are only eligible to obtain one NPI, and only one RAD will be issued which will include all payment/denial information for all the different Medi-Cal provider numbers replaced with the single NPI.
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B. Organizations (Entity Type 2)
Examples of organizations include hospitals, home health agencies, clinics, nursing homes, residential treatment centers, laboratories, ambulance companies, group practices, HMOs, supplier of Durable Medical Equipment (DME) and pharmacies.

9. Are group providers required to obtain an NPI?
   A: Yes. Group providers are considered Entity Type 2 (organization) providers and are required to obtain an NPI. Additionally, the rendering providers that work under the group are also required to obtain their own separate individual NPIs.
10. Does a hospital with different departments such as home health, Skilled Nursing Facility and acute outpatient services need to obtain separate NPIs?
    A: No, but there may be valid internal reasons such as billing operations, accounts receivable or reporting requirements that organizations such as hospitals with different departments may choose to “subpart” (obtain separate NPIs). Please refer to the Subparts page for more information. Also consider if there are other ways to identify your subordinate such as taxonomy codes, separate addresses or other data such as place of service. If the needs cannot be accomplished by the additional data, you may want to apply for a subpart NPI for this subordinate entity.
11. Can group practices with multiple locations and one Tax Identification Number (TIN) subpart?
    A: Yes. Group practices are considered organizations and may choose to subpart. Please refer to the Subparts page for more information.
12. Can Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) that currently have a Medi-Cal provider number for each location subpart?
    A: Yes. FQHCs or RHCs are considered organizations and may choose to subpart. Please refer to the Subparts page for more information.
13. Do all providers rendering services in a facility need to obtain an NPI?
    A: Providers rendering services in the facility are considered covered entities and are required to obtain an NPI for use to identify them in HIPAA-standard transactions. Effective December 17, 2007, DHCS only accepts either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise.
14. Are Adult Day Health Care (ADHC) centers required to obtain an NPI?
    A: Yes. The Department of Health Care Services has determined that ADHC centers are covered health care providers and are required to obtain an NPI for use in HIPAA-covered transactions with Medi-Cal. In addition to electronic transactions, Medi-Cal is also requiring an NPI on all paper claims.
15. Are corporations required to obtain an NPI?
    A: If the corporation is considered a covered health care provider under HIPAA, the NPI final rule requires them to obtain an NPI.
16. If one NPI replaces a facility’s multiple Medi-Cal provider numbers, will there be separate Remittance Advice Details (RAD) issued as they are today (for each Medi-Cal provider number)?
    A: No. When multiple provider numbers are replaced by a single NPI, only one RAD will be issued. The RAD will include all payment/denial information for the facility’s multiple Medi-Cal provider numbers replaced with the single NPI.
17. Are substance abuse counselors who provide services in a residential treatment center or a non-residential treatment center required to obtain an NPI?
    A: Yes. Substance abuse counselors are considered covered entities and are required to obtain an NPI. Effective December 17, 2007, DHCS only accepts either an NPIor a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise.
18. Are Local Educational Agency (LEA) providers required to obtain an NPI?
    A: Yes. The Department of Health Care Services has determined that LEA providers are covered health care providers and are required to obtain an NPI for use in HIPAA-covered transactions with Medi-Cal. In addition to electronic transactions, Medi-Cal is also requiring an NPI on all paper claims.
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C. General

19. Is NPPES disseminating the required information to Medi-Cal?
    A: No. The NPPES data dissemination process is not automatic. Although Medi-Cal does plan to participate in the process, it is not Medi-Cal’s intention to use the data to replace the NPI registration process. Medi-Cal intends to use the data to validate registered NPIs only.
20. Can an NPI be more or less than 10 digits?
    A: No. An NPI is 10 digits, all numeric.
21. Does a provider need to apply for an NPI to submit claims to Medi-Cal?
    A: Yes. Effective December 17, 2007, DHCS only accepts either an NPI or a Medi-Cal provider number. Providers who are not ready to transition to using the NPI may continue to submit their Medi-Cal provider number until instructed otherwise. Atypical providers will continue to use their Medi-Cal provider number.
22. How does a provider apply for an NPI?
    A: CMS has established the National Plan and Provider Enumeration System (NPPES) that enables a provider to apply for an NPI online. For additional information, and to complete an application, visit the NPPES Web site.
23. If a provider is not a HIPAA-covered entity, do they need to apply for an NPI?
    A: Please see the CMS HIPAA Web site for information on HIPAA-covered entities and who should apply for an NPI. Please note that the Medi-Cal program will be requiring an NPI on paper transactions that would otherwise not be considered a covered transaction. Only those providers considered “atypical” will be exempt from registering an NPI because they do not fit the definition of a HIPAA-covered entity.


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