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NPIs

Guidance for the National Provider Identifier.

Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: August 03, 2020

The National Provider Identifier (NPI) is the adopted standard mandated by HIPAA.

 

About NPIs

An NPI is a unique 10-digit number used to identify health care providers. All health care providers who are HIPAA-covered entities, whether individuals or organizations, must obtain an NPI.  

Once assigned, an NPI remains the same, even if the provider has a change of name, address, or other information. NPIs do not carry information about a provider, like geographic location or specialty.

An NPI must be used in all HIPAA standard transactions. 

CMS has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. 

 The Office of Burden Reduction and Health Informatics (OBRHI) National Standards Group (NSG), on behalf of the Department of Health and Human Services (HHS), has issued guidance to clarify the prohibition at 45 CFR § 162.412(b) that a health plan may not require a health care provider that has been assigned an NPI to obtain an additional NPI and an information bulletin to inform our stakeholders of the Federal Register notice that was displayed on March 1, 2024. The notice provides information on changes to data elements that health care providers are required to submit to the National Plan and Provider Enumeration System (NPPES) to obtain and maintain a National Provider Identifier (NPI). The changes to required data elements affect the data that is made available to the public from NPPES in downloadable files and in a query-only database on the Internet.

NSG has created a special mailbox to receive questions, comments and feedback on Guidance Letters, Bulletins, and FAQs, and any other related matters. The address for that mailbox is AdministrativeSimplification@cms.hhs.gov.

HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.

DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.