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impose penalties on covered entities that deploy contingency plans to facilitate the compliance of their trading partners (e.g., those healthcare providers who bill them). The posted guidance document can be used by covered entities to design and implement a contingency plan. Details are contained in a CMS document entitled, "Guidance on
Compliance with the HIPAA National Provider Identifier (NPI) Rule." Small health plans have one additional year to comply.
278:(PAC ID). With an increasing number of publicly available datasets containing these identifiers, some organizations have extracted the most plausible links between these identifiers. For example, a crosswalk between CCN and NPI can be obtained by analyzing the facility ownership datasets. As another example, a subset of the crosswalk between EIN and NPI can be derived by analyzing the provider reference files from various payers.
224:
The NPI number can be obtained online through the
National Plan and Provider Enumeration System (NPPES) pages on CMS's website. Turnaround time for obtaining a number is from 1 to 20 days. NPI numbers can be searched on the CMS website listed in external links 'National Plan and Provider Enumeration
233:
The NPI is a 10-position, intelligence-free numeric identifier (10-digit number). This means that the numbers do not carry other information about healthcare providers, such as the state in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the
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HIPAA–covered entities such as providers completing electronic transactions, healthcare clearinghouses, and large health plans were required by regulation to use only the NPI to identify covered healthcare providers by May 23, 2007. CMS subsequently announced that as of May 23, 2008, CMS will not
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HIPAA standards transactions. As outlined in the federal regulation, The Health
Insurance Portability and Accountability Act of 1996 (HIPAA), covered providers must also share their NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes.
249:
NPI data is downloadable from CMS. The downloadable database was updated monthly until
December 2012, and has been issued weekly since. A data structure file is available separately from CMS. As of June 2024, the file download size is 947.84 MB, and the raw database file
59:
All individual HIPAA–covered healthcare providers or organizations must obtain an NPI for use in all HIPAA standard transactions, even if a billing agency prepares the transaction. Individual HIPAA–covered healthcare providers include
258:
The NPI is a data key that identifies a substantial portion of healthcare providers and other entities in the US, it is a frequently used data key in other data sources. For instance, the DocGraph data set is a crowdfunded
250:(npidata_pfile_20050523-20240512.csv) is 9.3 GB when extracted. The size of the data has been steadily growing over time. The size of the raw database file was 8.8GB in June 2023, and 8.2GB in June 2022.
43:
services, and is used by other payers, including commercial healthcare insurers. The transition to the NPI was mandated as part of the
Administrative Simplifications portion of the
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by health care clearinghouses in their internal files to create and process standard transactions and to communicate with health care providers and health plans;
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The NPI must be used in connection with the electronic transactions identified in HIPAA. In addition, the NPI may be used in several other ways:
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set that details how healthcare providers collaborate to deliver care (i.e. referral patterns) that uses the NPI as its data key.
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by health care providers to identify themselves in health care transactions identified in HIPAA or on related correspondence;
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companies. Once assigned, a provider's NPI is permanent and remains with the provider regardless of job or location changes.
459:
182:
by health care providers to identify other health care providers in health care transactions or on related correspondence;
336:"National Plan and Provider Enumeration System (NPPES) National Provider Identifier (NPI) for Health Care Providers"
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by health plans in their internal provider files to process transactions and communicate with health care providers;
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40:
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105:
335:
113:
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Other health industry workers who provide support services but not health care (such as admissions and
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The NPI is often a common denominator between various healthcare provider identifier numbers, such as
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to cross reference health care providers in fraud and abuse files and other program integrity files;
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by health care providers on prescriptions (however, the NPI will not replace requirements for the
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National Plan and
Provider Enumeration System (NPPES) Data Dissemination – Readme
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personnel, housekeeping staff and orderlies) are not required to obtain an NPI.
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systems to identify treating health care providers in patient medical records;
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367:"Requirements for the National Provider Identifier (NPI) and NPI Check Digit"
338:. Centers for Medicare & Medicaid Services. Retrieved February 14, 2007.
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304:. Centers for Medicare & Medicaid Services. Retrieved August 15, 2006.
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315:"Frequently Asked Questions about the National Provider Identifier"
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for any other lawful activity requiring individual identification.
514:"A crosswalk between NPI and EIN/TIN (a free NPI look-up tool)"
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by health plans to coordinate benefits with other health plans;
478:"Medicare Fee-For-Service Public Provider Enrollment Data"
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Identification number issued to U.S. health care providers
27:) is a unique 10-digit identification number issued to
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544:
45:
Health
Insurance Portability and Accountability Act
237:Ten-digit NPI numbers may be validated using the
496:"A crosswalk between NPI and CCN (open data)"
460:"ResDAC CMS Certification Number Description"
349:"National Provider Identifier Standard (NPI)"
241:by prefixing "80840" to the 10-digit number.
8:
33:Centers for Medicare and Medicaid Services
570:2006 establishments in the United States
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210:Department of Health and Human Services
39:(UPIN) as the required identifier for
37:Unique Physician Identification Number
31:providers in the United States by the
560:Medicare and Medicaid (United States)
540:National Provider Identifier Standard
7:
436:"DocGraph: Open social doctor data"
14:
35:(CMS). The NPI has replaced the
272:Employer Identification Number
270:(CCN; formerly OSCAR number),
225:System information from CMS'.
1:
295:"HIPAA - General Information"
146:residential treatment centers
535:Official NPI Registry Search
434:Trotter, Fred (2012-11-19).
21:National Provider Identifier
586:
276:PECOS Associate Control ID
203:electronic patient record
189:or state license number);
138:home health care agencies
268:CMS Certification Number
132:. Organizations include
317:. HHS. 21 November 2000
114:occupational therapists
106:professional counselors
102:clinical social workers
92:, licensed opticians,
126:pharmacy technicians
70:physician assistants
148:, group practices,
110:physical therapists
78:nurse practitioners
300:2007-06-11 at the
229:Identifier details
82:nurse anesthetists
421:www.medstartr.com
254:Use as a data key
158:medical equipment
130:athletic trainers
47:of 1996 (HIPAA).
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403:download.cms.gov
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302:Wayback Machine
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165:medical billing
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529:External links
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440:O'Reilly Radar
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239:Luhn algorithm
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220:Signup process
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376:. 2004-01-23.
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245:Open data set
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171:Optional uses
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142:nursing homes
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98:chiropractors
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51:Mandated uses
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482:Data.CMS.gov
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443:. Retrieved
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319:. Retrieved
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150:laboratories
118:prosthetists
94:optometrists
58:
54:
24:
20:
18:
565:Identifiers
417:"MedStartr"
399:"NPI Files"
66:pharmacists
29:health care
554:Categories
545:NPI Lookup
518:NPI-DB.org
445:2017-10-24
187:DEA number
154:pharmacies
122:orthotists
90:denturists
62:physicians
261:open data
134:hospitals
321:July 16,
298:Archived
86:dentists
74:midwives
41:Medicare
374:CMS.gov
353:CMS.gov
208:by the
500:GitHub
464:ResDAC
274:, and
370:(PDF)
282:Notes
323:2019
156:and
128:and
201:by
25:NPI
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72:,
68:,
64:,
19:A
520:.
502:.
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448:.
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325:.
23:(
Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.